System and method for improving the accommodative amplitude and increasing the refractive power of the human lens with a laser

ABSTRACT

A system and method for increasing the amplitude of accommodation and/or changing the refractive power of lens material of a natural crystalline lens is provided. Generally, there is provided methods and systems for delivering a laser beam to a lens of an eye in a plurality of patterns results in the increased accommodative amplitude and/or refractive power of the lens. There is further provided a system and method of treating presbyopia by increasing both the flexibility of the human lens and the depth of field of the eye.

Applicants claim, under 35 U.S.C. §§ 120 and 365, the benefit ofpriority of the filing date of Jan. 19, 2007 of a Patent CooperationTreaty patent application Serial Number PCT/US07/001353, filed on theaforementioned date, the entire contents of which are incorporatedherein by reference, wherein Patent Cooperation Treaty patentapplication Serial Number PCT/US07/001353 is a continuation-in-part ofpending application Frey et al. Ser. No. 11/414,838 filed on May 1,2006, and a continuation-in-part of Frey et al. Ser. No. 11/414,819filed May 1, 2006, which are both continuation-in-parts of pendingapplication Frey et al. Ser. No. 11/337,127 filed Jan. 20, 2006, thedisclosures of each of the above mentioned pending applications areincorporated herein by reference.

BACKGROUND OF THE INVENTION

The present invention relates to systems and methods for treating thestructure of the natural human crystalline lens with a laser to addressa variety of medical conditions such as presbyopia, refractive error andcataracts and combinations of these.

The anatomical structures of the eye are shown in general in FIG. 1,which is a cross sectional view of the eye. The sclera 131 is the whitetissue that surrounds the lens 103 except at the cornea 101. The cornea101 is the transparent tissue that comprises the exterior surface of theeye through which light first enters the eye. The iris 102 is a colored,contractible membrane that controls the amount of light entering the eyeby changing the size of the circular aperture at its center (the pupil).The ocular or natural crystalline lens 103, a more detailed picture ofwhich is shown in FIGS. 1A-F, (utilizing similar reference numbers forsimilar structures) is located just posterior to the iris 102. The termsocular lens, natural crystalline lens, natural lens, natural humancrystalline lens, and lens (when referring to the prior terms) are usedinterchangeably herein and refer to the same anatomical structure of thehuman eye.

Generally, the ocular lens changes shape through the action of theciliary muscle 108 to allow for focusing of a visual image. A neuralfeedback mechanism from the brain allows the ciliary muscle 108, actingthrough the attachment of the zonules 111, to change the shape of theocular lens. Generally, sight occurs when light enters the eye throughthe cornea 101 and pupil, then proceeds through the ocular lens 103through the vitreous 110 along the visual axis 104, strikes the retina105 at the back of the eye, forming an image at the macula 106 that istransferred by the optic nerve 107 to the brain. The space between thecornea 101 and the retina 105 is filled with a liquid called the aqueous117 in the anterior chamber 109 and the vitreous 110, a gel-like clearsubstance, in the chamber posterior to the lens 103.

FIG. 1A illustrates, in general, components of and related to the lens103 for a typical 50-year old individual. The lens 103 is amulti-structural system. The lens 103 structure includes a cortex 113,and a nucleus 129, and a lens capsule 114. The capsule 114 is an outermembrane that envelopes the other interior structures of the lens. Thelens epithelium 123 forms at the lens equatorial 121 generatingribbon-like cells or fibrils that grow anteriorly and posteriorly aroundthe ocular lens. The nucleus 129 is formed from successive additions ofthe cortex 113 to the nuclear regions. The continuum of layers in thelens, including the nucleus 129, can be characterized into severallayers, nuclei or nuclear regions. These layers include an embryonicnucleus 122, a fetal nucleus 130, both of which develop in the womb, aninfantile nucleus 124, which develops from birth through four years foran average of about three years, an adolescent nucleus 126, whichdevelops from about four years until puberty, which averages about 12years, and the adult nucleus 128, which develops at about 18 years andbeyond.

The embryonic nucleus 122 is about 0.5 mm in equatorial diameter (width)and 0.425 mm in Anterior-Posterior axis 104 (AP axis) diameter(thickness). The fetal nucleus 130 is about 6.0 mm in equatorialdiameter and 3.0 mm in AP axis 104 diameter. The infantile nucleus 124is about 7.2 mm in equatorial diameter and 3.6 mm in AP axis 104diameter. The adolescent nucleus 126 is about 9.0 mm in equatorialdiameter and 4.5 mm in AP axis 104 diameter. The adult nucleus 128 atabout age 36 is about 9.6 mm in equatorial diameter and 4.8 mm in APaxis 104 diameter. These are all average values for a typical adulthuman lens approximately age 50 in the accommodated state, ex vivo.Thus, this lens (nucleus and cortex) is about 9.8 mm in equatorialdiameter and 4.9 mm in AP axis 104 diameter. Thus, the structure of thelens is layered or nested, with the oldest layers and oldest cellstowards the center.

The lens is a biconvex shape as shown in FIGS. 1 and 1A. The anteriorand posterior sides of the lens have different curvatures, and thecortex and the different nuclei in general follow those curvatures.Thus, the lens can be viewed as essentially a stratified structure thatis asymmetrical along the equatorial axis and consisting of longcrescent fiber cells arranged end-to-end to form essentially concentricor nested shells. The ends of these cells align to form suture lines inthe central and paracentral areas both anteriorly and posteriorly. Theolder tissue in both the cortex and nucleus has reduced cellularfunction, having lost their cell nuclei and other organelles severalmonths after cell formation.

Compaction of the lens occurs with aging. The number of lens fibers thatgrow each year is relatively constant throughout life. However, the sizeof the lens does not become as large as expected from new fiber growth.The lens grows from birth through age 3, from 6 mm to 7.2 mm or 20%growth in only 3 years. Then, in the next approximate decade, growth isfrom 7.2 mm to 9 mm or 25%; however, this is over a 3 times longerperiod of 9 years. Over the next approximate two decades, from age 12 toage 36, the lens grows from 9 mm to 9.6 mm or 6.7% growth in 24 years,showing a dramatically slowing observed growth rate, while we believethere is a relatively constant rate of fiber growth during this period.Finally, in the last approximately 2 decades described, from age 36 toage 54, the lens grows by a tiny fraction of its youthful growth, from9.6 to 9.8 mm or 2.1% in 18 years. Although there is a geometry effectof needing more lens fibers to fill larger outer shells, the size of theolder lens is considerably smaller than predicted by fiber growth ratemodels, which consider geometry effects. Fiber compaction includingnuclear fiber compaction is thought to explain these observations.

In general, presbyopia is the loss of accommodative amplitude. Ingeneral, refractive error is typically due to variations in the axiallength of the eye. Myopia is when the eye is too long resulting in thefocus falling in front of the retina. Hyperopia is when the eye is tooshort resulting in the focus falling behind the retina. In general,cataracts are areas of opacification of the ocular lens which aresufficient to interfere with vision. Other conditions, for which thepresent invention is directed, include but are not limited to theopacification of the ocular lens.

Presbyopia most often presents as a near vision deficiency, theinability to read small print, especially in dim lighting after about40-45 years of age. Presbyopia, or the loss of accommodative amplitudewith age, relates to the eye's inability to change the shape of thenatural crystalline lens, which allows a person to change focus betweenfar and near, and occurs in essentially 100% of the population.Accommodative amplitude has been shown to decline with age steadilythrough the fifth decade of life.

Historically, studies have generally attributed loss of accommodation tothe hardening of the crystalline lens with age and more specifically, toan increase in the Young's Modulus of Elasticity of the lens material.More recent studies have examined the effect of aging on the relativechange in material properties between the nucleus and cortex. Thesestudies have provided varying theories and data with respect to thehardening of the lens. In general, such studies have essentiallyproposed the theory that the loss of flexibility is the result of anincrease in the Young's Modulus of Elasticity of the nucleus and/orcortex material. Such studies have viewed this hardening as the primaryfactor in the loss of accommodative amplitude with age and hence thecause of presbyopia.

Although the invention is not bound by it, the present specificationpostulates a different theory of how this loss of lens flexibilityoccurs to cause presbyopia. In general, it is postulated that thestructure of the lens, rather than the material properties of the lens,plays a greater role in loss of flexibility and resultant presbyopiathan was previously understood. Thus, contrary to the teachings of theprior studies in this field as set forth above, material elasticity isnot the dominate cause of presbyopia. Rather, it is postulated that thestructure of the lens and changes in that structure with age are thedominant cause of presbyopia. Thus, without being limited to or bound bythis theory, the present invention discloses a variety of methods andsystems to provide laser treatments to increase the flexibility of thelens, based at least in part on the structure of the lens and structuralchanges that occur to the lens with aging. The present invention furtherdiscloses providing laser treatments to increase the flexibility of thelens that are based primarily on the structure of the lens andstructural changes that occur to the lens with aging.

Accordingly, the postulated theory of this specification can beillustrated for exemplary purposes by looking to and examining a simplehypothetical model. It further being understood this hypothetical modelis merely to illustrate the present theory and not to predict how a lenswill react to laser pulses, and/or structural changes. To understand howimportant structure alone can be, consider a very thin plank of wood,say 4 ft by 4 ft square but 0.1 inch thick. This thin plank is not verystrong and if held firmly on one end, it does not take much force tobend this thin plank considerably. Now consider five of these same 0.1inch thickness planks stacked on top of each other, but otherwise notbound or tied together. The strength would increase and for the sameforce a somewhat smaller deflection will occur. Now, consider takingthose same five planks and fastening them together with many screws orby using very strong glue, or by using many C-Clamps to bind themtogether. The strength of the bound planks is much higher and thedeflection seen from the same force would be much smaller.

Without saying this simple model reflects the complex behavior of thelens, we generally hypothesize that when considering a volume of lensmaterial, especially near the poles (AP axis), that is essentially boundby increased friction and compaction due to aging, that separating thosebound layers into essentially unbound layers will increase thedeflection of those layers for the same applied force and hence increaseflexibility of the lens. Applicants, however, do not intend to be boundby the present theory, and it is provided solely to advance the art, andis not intended to and does not restrict or diminish the scope of theinvention,

Thus, further using this model for illustration purposes, under theprior theories and treatments for presbyopia, the direction wasprincipally toward the material properties, i.e., Modulus of thematerial in the stack, rather than on the structure of the stack, i.e.,whether the layers were bound together. On the other hand, the presentlypostulated theory is directed toward structural features and the effectsthat altering those features have on flexibility.

In general, current presbyopia treatments tend to be directed towardalternatives to increasing the amplitude of accommodation of the naturalcrystalline lens. These treatments include a new class of artificialaccommodative Intraocular Lenses (IOL's), such as the EyeonicsCRYSTALENS, which are designed to change position within the eye;however, they offer only about 1 diopter of objectively measuredaccommodative amplitude, while many practitioners presently believe 3 ormore diopters are required to restore normal visual function for nearand far objects. Moreover, researchers are pursuing techniques andmaterials to refill the lens capsule with synthetic materials.Additionally, present surgical techniques to implant artificialaccommodative IOL's are those developed for the more serious conditionof cataracts. It is believed that practitioners are reluctant at thepresent time to replace a patient's clear albeit presbyopic naturalcrystalline lens, with an accommodative IOL due to the risks of thisinvasive surgical technique on a patient who may simply wear readingglasses to correct the near vision deficiency. However, developments mayoffer greater levels of accommodative amplitude in implantable devicesand refilling materials. To better utilize such device improvements andto increase the accommodative amplitude of existing implantable devices,improved surgical techniques are provided herein as a part of thepresent invention.

Refractive error, typically due to the length of the eye being too long(myopia) or too short (hyperopia) is another very common problemeffecting about one-half of the population. Laser surgery on the cornea,as proposed by Trokel and L'Esperance and improved by Frey and others,does offer effective treatment of refractive errors but factors such ashigher degrees of refractive error, especially in hyperopia, thincorneas or a changing refractive error with time, such as that broughton by presbyopia, limit the clinical use of laser corneal surgery formany.

Cataracts, or the condition when the natural crystalline lens becomesopaque and clouds vision, occurs in millions of people per year and aretreated effectively with a surgical techniques such as ultrasonicphacoemulsification pioneered by Kelman 30 years ago. Although thetechniques have been refined over the years, safety concerns from oculartrauma, especially to the corneal endothelium from the ultrasonic energyrequired to break up a hardened cataract is undesirable; especially forthose with a compromised corneal endothelium, such as those with FuchsDystrophy. Moreover, the use of lasers in the treatment of cataracts hasa further issue. Cataracts scatter light, including laser light and thuscan prevent a laser treatment beam from having the desired tissueeffect. Accordingly, as provided in detail in this specificationimprovements in the delivery of lasers to cataractous tissue areprovided herein.

SUMMARY

Provided herein are embodiments of the present invention. Accordingly,there is provided a system and method for delivering a laser beam to alens of an eye in a plurality of patterns, which system and method ingeneral comprise providing a laser, providing an optical path fordirecting a laser beam from the laser to the lens of the eye, directingthe laser beam in a first pattern on a first portion of the lens of theeye, the first pattern generally following the shape of the outersurface of the lens of the eye, directing the laser beam in a secondpattern on a second portion of the lens of the eye, the second patternhaving a pattern to cover a specific volume of the second portion of thelens of the eye and wherein the relationship of the first pattern to thesecond pattern being such that the first pattern is positioned withinthe lens closer to the lens outer surface than the second pattern; and,both the first and second patterns positioned within the lens of the eyesuch that they avoid the central portion of the lens of the eye. In thissystem and method the second pattern may be cubic, the first shotpattern may be a plurality of nested shells, the first shot pattern maycomprises a plurality of nested shells that follows the anterior surfaceof the lens of the eye, or other combinations and of patterns disclosedand taught herein. These shot patterns may further be delivered to thelens of the eye in a random manner. These shot patterns may stillfurther have a central area avoided wherein the central area avoided hasa width of about 1 mm centered approximately on the optical axis of thelens, wherein the central area avoided has is cylindrical in shape andhas a diameter greater than about 1 mm centered approximately around theoptical axis of the lens, wherein the central area avoided has a widthof about 1.5 mm centered approximately on the optical axis of the lens,wherein the central area avoided is cylindrical in shape and has adiameter greater than about 1.5 mm centered approximately around theoptical axis of the lens, wherein the central area avoided has a widthof about 0.2 mm to about 4 mm centered approximately on the optical axisof the lens, wherein the central area avoided is cylindrical in shapeand has a diameter of about 0.2 mm to about 4 mm centered approximatelyaround the optical axis of the lens, wherein the central area avoided iscylindrical in shape and has a diameter of about 0.2 mm to about 4 mmcentered approximately around the optical axis of the lens, wherein thecentral area avoided has a diameter of about 0.5 mm to about 3 mmcentered approximately around the optical axis of the lens, wherein thecentral area avoided is cylindrical in shape and has a diameter of about2 mm centered approximately around the optical axis of the lens, andwherein the second pattern is different from the first pattern, as wellas other variations provide in the detailed description. These shotpatterns may further be delivered to the lens of the eye in a randommanner.

There is also provided a system and method of increasing depth of fieldfor human vision, which system and method in general comprise providingan aperture for the lens of an eye; the aperture being formed frommaterial comprising an opacified annulus of human lens material. In thesystem and method the annulus may be about 100% opacified, about 90%opacified, about 50% to about 100% opacified, about 20% to about 100%opacified, and other amounts of opacification between and around theseamounts as taught herein. Further the method and system of increasingdepth of field for human vision may in general comprise providing anannulus of opacified material within the lens of an eye with the annulusbeing positioned away from the outer surfaces of the lens by at leastabout 0.25 mm. In a further system and method the annulus creates anaperture having a diameter of about 2 mm, as well as other variations asprovided in the detailed description.

Additionally, there is provided methods and systems for treatingpresbyopia by increasing both the flexibility of the human lens and thedepth of field of the eye. Thus, there may be provided an aperture forthe lens of an eye, the aperture being formed from material comprisingan opacified annulus of human lens material, in conjunction withproviding a laser shot pattern to increase the flexibility of the lens.Further and more detailed implementations of this method and system areprovided in the detailed description. These shot patterns may further bedelivered to the lens of the eye in a random manner.

Further provided herein is a system for creating an annulus of opacifiedmaterial from the lens of an eye, which system in general comprises alaser, laser focusing optics for providing a laser shot, a scanner and acontrol system comprising a pattern for directing a plurality of lasershots in an annular pattern to a portion of the lens of the eye, so thatthe laser shots so directed are predetermined to opacify the lensmaterial. In this system the annular pattern may have an inner diameterof from about 0.5 mm to about 3 mm, the annular pattern may be centeredapproximately on the optical axis of the eye, the laser shots may bepredetermined to opacify the lens material to from about 20% to about100% opacification, as well as, other variations as provided in thedetailed description. These shot patterns may further be delivered tothe lens of the eye in a random manner.

Moreover, there is provided a system and a method of using this systemfor treating presbyopia which in general comprise a laser and laserfocusing optics for providing a laser shot, a scanner; and, a controlsystem comprising a first pattern for directing a plurality of lasershots in an annular pattern to a portion of the lens of the eye; and, asecond pattern for directly a plurality of laser shots to a portion ofthe lens of the eye, and wherein the laser shots so directed in thefirst pattern are predetermined to opacify the lens material and thelaser shots so directed in the second pattern are predetermined toincrease the flexibility of the lens. In this system and method thefirst and second patterns may be provided to the lens of the eyesubstantially simultaneously or simultaneously, the second pattern mayprovide a pattern of nested shells, and the second pattern may bepredetermined to avoid placing any laser shots in the central portion ofthe lens. Further, the central area avoided may have a width of about 1mm centered approximately on the optical axis of the lens, the centralarea avoided may be cylindrical in shape and have a diameter greaterthan about 1 mm centered approximately around the optical axis of thelens, the central area avoided may have a width of about 1.5 mm centeredapproximately on the optical axis of the lens, the central area avoidedmay be cylindrical in shape and have a diameter greater than about 1.5mm centered approximately around the optical axis of the lens, thecentral area avoided may have a width of about 0.2 mm to about 4 mmcentered approximately on the optical axis of the lens, the central areaavoided may be cylindrical in shape and have a diameter of about 0.2 mmto about 4 mm centered approximately around the optical axis of thelens, the central area avoided may be cylindrical in shape and have adiameter of about 0.2 mm to about 4 mm centered approximately around theoptical axis of the lens, the central area avoided may have a diameterof about 0.5 mm to about 3 mm centered approximately around the opticalaxis of the lens, the central area avoided may be cylindrical in shapeand have a diameter of about 2 mm centered approximately around theoptical axis of the lens, the annular pattern may have an inner diameterof from about 0.2 mm to about 4 mm, as well as, other variations asprovided in the detailed description. These shot patterns may further bedelivered to the lens of the eye in a random manner.

There is still further provided a method and system for treatingpresbyopia in general comprising providing a laser beam to a portion ofthe lens of an eye, the portion consisting essentially of denucleatedmaterial. Thus, this system may be comprised of a laser, laser focusingoptics, a scanner, and, a control system comprising a pattern fordirecting a plurality of laser pulses from the laser in a pattern to aportion of the lens of the eye, said portion consisting essentially ofdenucleated material. Further provided is a method for treatingpresbyopia in general comprising providing a laser beam in a shotpattern to a portion of a lens of an eye, the lens having an organelledegradation region and an organelle free regions, the shot patternconsisting essentially of shots directed toward the organelledegradation and/or organelle free regions of the lens of the eye. Stillfurther there is provided a system and method for treating presbyopia ingeneral comprising providing a laser beam in a shot pattern to a portionof a lens of an eye the lens having an organelle free region the shotpattern consisting essentially of shots directed toward the organellefree region of the lens of the eye. These shot patterns may further bedelivered to the lens of the eye in a random manner.

Also, there is provided a system and method for delivering laser burststo a lens of an eye in a pattern, this system and method in generalcomprise a laser for providing laser pulses, laser optics, for providinga plurality of bursts of laser pulses, the bursts in the plurality ofbursts comprising a plurality of individual laser pulses, a scanner, thescanner having a scan rate, and, a control system, the control systemcomprising a predetermined laser shot pattern for directing the laser toa portion of the lens of the eye, the shot pattern comprising aplurality of points, wherein the scan rate is such that at least amajority of the pulses in any one burst in said plurality of bursts isplaced nearer to a point than to other points in the shot pattern.

Further, there is provided a system and method for delivering a laserbeam to a lens of an eye while increasing the probability of achievingLIOB, as defined in the detailed description, and reducing the Rayleighrange effect in general comprising a laser for providing laser pulses,the energy density for the laser pulses being predetermined to be at ornear LIOB threshold, laser optics, for providing a plurality of burstsof laser pulses, the bursts in the plurality of bursts comprising aplurality of individual laser pulses, a scanner, the scanner having ascan rate; and, a control system, the control system comprising apredetermined laser shot pattern for directing the laser to a portion ofthe lens of the eye, the shot pattern comprising a plurality of shots,wherein the number of pulses in a burst is at least great enough toprovide at least a 90% chance of obtaining LIOB at a spot in the lenscorresponding to a shot in the shot pattern. Yet further, there isprovided a method and system for delivering laser bursts to a lens of aneye in a pattern comprising a laser for providing laser pulses, thelaser pulses spaced apart by time t₁ , as defined in the detaileddescription, laser optics, for providing a plurality of bursts of laserpulses, the bursts in the plurality of bursts comprising a plurality ofindividual laser pulses, the bursts being spaced apart by time t₃, asdefined in the detailed description, a scanner, and, a control system,the control system comprising a predetermined laser shot pattern fordirecting the laser to a portion of the lens of the eye, the shotpattern comprising a plurality of shots. Moreover, it may be such thatwherein time t₁ is about 5 nanoseconds to about 20 nanoseconds and timet₃ is about 5 μseconds to about 33 μ seconds and the scanner has a scanrate of about 30 kHz to about 200 kHz. These shot patterns may furtherbe delivered to the lens of the eye in a random manner.

There is still further provided a system and a method for delivering alaser beam to a lens of an eye in a plurality of patterns in generalcomprising a laser, an optical path for directing a laser beam from thelaser to the lens of the eye, and, a control system for at leastdirecting the laser beam in a shot pattern in the lens of the eye, thepattern being arranged in the lens of the eye in a substantially randommanner.

Further there is provided a system and a method for delivering a laserbeam to a lens of an eye in a pattern in general comprising a laser, anoptical path for directing a laser beam from the laser to the lens ofthe eye, the optical path having an F/# greater than or equal to about1.5, a control system for at least directing the laser beam in a shotpattern in the lens of the eye, the pattern consisting essential of apattern of shots arranged vertically. The F/# may in this system begreater or equal to about 2. Moreover, there is provided a system fordelivering a laser beam to a lens of an eye in a pattern in generalcomprising, a laser, an optical path for directing a laser beam from thelaser to the lens of the eye, the optical path proving a laser spot sizeof x a control system for at least directing the laser beam in a shotpattern in the lens of the eye, the pattern consisting essential of apattern of shots arranged vertically, said shots in said verticalpattern being spaced apart by less than 3×.

One of ordinary skill in the art will recognize, based on the teachingsset forth in these specifications and drawings, that there are variousembodiments and implementations of these teachings to practice thepresent invention. Accordingly, the embodiments in this summary are notmeant to limit these teachings in any way.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1 and 1A are cross sectional representations of the human eye.

FIG. 2 is a block schematic diagram of a type of system for delivering alaser beam shot pattern to the lens of an eye according to the teachingsof the present invention.

FIG. 2A is a block schematic diagram of illustrative components forminga portion of a system for delivering a laser beam shot pattern to thelens of an eye according to the teachings of the present invention.

FIG. 3 is a diagram of the anterior surface of a lens normal to the APaxis illustrating a laser shot pattern having a flower like shape whichhas a contour generally following approximately the last 15% of thefiber length from the end of the fiber.

FIGS. 4A, 4B, 4C, 4D and 4E are diagrams representing elevation views ofthe geometry used for the development of laser shot patterns based uponthe structure of the fetal nucleus (three suture branch nucleus) as itis rotated from the posterior view 4A through and to the anterior view4E.

FIGS. 5A, 5B, and 5C are diagrams representing posterior, side andanterior elevation views, respectively, of the geometry used for thedevelopment of laser shot patterns based upon the structure of theinfantile nucleus (six suture branch nucleus).

FIGS. 6A, 6B and 6C are diagrams representing posterior, side andanterior elevation views, respectively of the geometry used for thedevelopment of laser shot patterns based upon the structure of theadolescent nucleus (nine suture branch nucleus).

FIGS. 7A, 7B and 7C are diagrams representing posterior, side andanterior elevation views, respectively of the geometry used for thedevelopment of laser shot patterns based upon the structure of the anadult nucleus (12 suture branch).

FIGS. 8 and 8A are perspective cutout views of an adult lensrepresenting the placement of essentially concentric shells inaccordance with the teachings of the present invention.

FIG. 9 is a cross-section drawing of the lens relating to the modeldeveloped by Burd.

FIG. 10 is a cross-section drawing of a lens based upon the modeldeveloped by Burd.

FIG. 11 is a cross-section drawing of a lens based upon the modeldeveloped by Burd.

FIG. 12 is a cross-section drawing of a lens based upon the modeldeveloped by Burd.

FIGS. 13-21 are cross-section drawings of lens illustrating a laser shotpattern.

FIG. 22 is a drawing of laser pulses and bursts.

FIGS. 23-24 are cross-section drawings of lens illustrating verticallaser shot patterns.

DETAILED DESCRIPTION OF THE DRAWINGS AND THE PREFERRED EMBODIMENTS

In general, the present invention provides a system and method forincreasing the amplitude of accommodation and/or changing the refractivepower and/or enabling the removal of the clear or cataractous lensmaterial of a natural crystalline lens. Thus, as generally shown in FIG.2 there is provided a system for delivering a laser beam shot pattern tothe lens of an eye comprising: a patient support 201; a laser 202;optics for delivering the laser beam 203; a control system fordelivering the laser beam to the lens in a particular pattern 204, whichcontrol system 204 is associated with and/or interfaces with the othercomponents of the system as represented by lines 205; a means fordetermining the position of lens with respect to the laser 206, whichmeans 206 receives an image 211 of the lens of the eye; and a laserpatient interface 207.

The patient support 201 positions the patent's body 208 and head 209 tointerface with the optics for delivering the laser beam 203.

In general, the laser 202 should provide a beam 210 that is of awavelength that transmits through the cornea, aqueous and lens. The beamshould be of a short pulse width, together with the energy and beamsize, to produce photodisruption. Thus, as used herein, the term lasershot or shot refers to a laser beam pulse delivered to a location thatresults in photodisruption. As used herein, the term photodisruptionessentially refers to the conversion of matter to a gas by the laser. Inparticular, wavelengths of about 300 nm to 2500 nm may be employed.Pulse widths from about 1 femtosecond to 100 picoseconds may beemployed. Energies from about a 1 nanojoule to 1 millijoule may beemployed. The pulse rate (also referred to as pulse repetition frequency(PRF) and pulses per second measured in Hertz) may be from about 1 KHzto several GHz. Generally, lower pulse rates correspond to higher pulseenergy in commercial laser devices. A wide variety of laser types may beused to cause photodisruption of ocular tissues, dependent upon pulsewidth and energy density. Thus, examples of such lasers would include:the Delmar Photonics Inc. Trestles-20, which is a Titanium Sapphire(Ti:Sapphire) oscillator having a wavelength range of 780 to 840 nm,less than a 20 femtosecond pulse width, about 100 MHz PRF, with 2.5nanojoules; the Clark CPA-2161, which is an amplified Ti:Sapphire havinga wavelength of 775 nm, less than a 150 femtosecond pulse width, about 3KHz PRF, with 850 microjoules; the IMRA FCPA (fiber chirped pulseamplification) μJewel D series D-400-HR, which is a Yb:fiberoscillator/amplifier having a wavelength of 1045 nm, less than a 1picosecond pulse width, about 5 MHz PRF, with 100 nanojoules; the LumeraStaccato, which is a Nd:YVO4 having a wavelength of 1064 nm, about 10picosecond pulse width, about 100 KHz PRF, with 100 microjoules; theLumera Rapid, which is a ND:YVO4 having a wavelength of 1064 nm, about10 picosecond pulse width, and can include one or more amplifiers toachieve approximately 2.5 to 10 watts average power at a PRF of between25 kHz to 650 kHz and also includes a multi-pulsing capability that cangate two separate 50 MHz pulse trains; and, the IMRA FCPA (fiber chirpedpulse amplification) μJewel D series D-400-NC, which is a Yb:fiberoscillator/amplifier having a wavelength of 1045 nm, less than a 100picosecond pulse width, about 200 KHz PRF, with 4 microjoules.

In general, the optics for delivering the laser beam 203 to the naturallens of the eye should be capable of providing a series of shots to thenatural lens in a precise and predetermined pattern in the x, y and zdimension. The optics should also provide a predetermined beam spot sizeto cause photodisruption with the laser energy reaching the naturallens. Thus, the optics may include, without limitation: an x y scanner;a z focusing device; and, focusing optics. The focusing optics may beconventional focusing optics, and/or flat field optics and/ortelecentric optics, each having corresponding computer controlledfocusing, such that calibration in x, y, z dimensions is achieved. Forexample, an x y scanner may be a pair of closed loop galvanometers withposition detector feedback. Examples of such x y scanners would be theCambridge Technology Inc. Model 6450, the SCANLAB hurrySCAN and theAGRES Rhino Scanner. Examples of such z focusing devices would be thePhsyik International Peizo focus unit Model ESee Z focus control and theSCANLAB varrioSCAN.

In general, the control system for delivering the laser beam 204 may beany computer, controller, and/or software hardware combination that iscapable of selecting and controlling x y z scanning parameters and laserfiring. These components may typically be associated at least in partwith circuit boards that interface to the x y scanner, the z focusingdevice and/or the laser. The control system may also, but does notnecessarily, have the further capabilities of controlling the othercomponents of the system as well as maintaining data, obtaining data andperforming calculations. Thus, the control system may contain theprograms that direct the laser through one or more laser shot patterns.

In general, the means for determining the position of the lens withrespect to the laser 206 should be capable of determining the relativedistance with respect to the laser and portions of the lens, whichdistance is maintained constant by the patient interface 207. Thus, thiscomponent will provide the ability to determine the position of the lenswith respect to the scanning coordinates in all three dimensions. Thismay be accomplished by several methods and apparatus. For example, x ycentration of the lens may be accomplished by observing the lens througha co-boresighed camera system and display or by using direct view opticsand then manually positioning the patients' eye to a known center. The zposition may then be determined by a range measurement device utilizingoptical triangulation or laser and ccd system, such as the Micro-Epsilonopto NCDT 1401 laser sensor and/or the Aculux Laser Ranger LR2-22 . Theuse of a 3-dimensional viewing and measurement apparatus may also beused to determine the x, y and z positions of the lens. For example, theHawk 3 axis non-contact measurement system from Vision Engineering couldbe used to make these determinations. Yet a further example of anapparatus that can be used to determine the position of the lens is a3-dimension measurement apparatus. This apparatus would comprise acamera, which can view a reference and the natural lens, and would alsoinclude a light source to illuminate the natural lens. Such light sourcecould be a structured light source, such as for example a slitillumination designed to generate 3-dimensional information based upongeometry.

A further component of the system is the laser patient interface 207.This interface should provide that the x, y, z position between thenatural lens and the laser remains fixed during the procedure, whichincludes both the measurement steps of determining the x y z positionand the delivery step of delivering the laser to the lens in a shotpattern. The interface device may contain an optically transparentapplanator. One example of this interface is a suction ring applanatorthat is fixed against the outer surface of the eye and is thenpositioned against the laser optical housing, thus fixing the distancebetween the laser, the eye and the natural lens. The reference marks forthe 3-dimensional viewing and measuring apparatus may also be placed onthis applanator. A further example of a laser patient interface is adevice having a lower ring, which has suction capability for affixingthe interface to the eye. The interface further has a flat bottom, whichpresses against the eye flattening the eye's shape. This flat bottom isconstructed of material that transmits the laser beam and alsopreferably, although not necessarily, transmits optical images of theeye within the visible light spectrum. The upper ring has a structurefor engaging with the housing for the laser optics and/or some structurethat is of known distance from the laser along the path of the laserbeam and fixed with respect to the laser. The flat bottom further has areference, which consists of three reference marks. Although three marksare provided in this example to make up the reference, the reference mayconsist of only a single mark or several marks. Further examples of suchdevices are generally disclosed in US D462442, US D462443, and USD459807S, the disclosures of which are hereby incorporated by reference.As an alternative to an applanator, the interface may be a cornealshaped transparent element whereby the cornea is put into direct contactwith the interface or contains an interface fluid between.

An illustrative combination utilizing by way of example specific opticsfor delivering the laser beam 203 and means for determining the positionof the lens 206, is shown in part, in FIG. 2A. FIG. 2A is a moredetailed schematic diagram of a configuration of the system of FIG. 2.Thus, the example of FIG. 2A provides a laser 202, laser optics fordelivering the laser beam 203, which optics comprise a beam expandertelescope 220, a z focus mechanism 221, a beam combiner 222, an x yscanner 223, and focusing optics 224. There is further provided in FIG.2A relay optics 230, camera optics with zoom and focus 231, and a ccdcamera 232, which components form a part of a three-dimensional viewingand measuring apparatus. Moreover, these components 230, 231 and 232 incombination with a light source 233, the reference mark 212 and thescanner 223 function as a means for determining the position of the lens206.

This combination of FIG. 2A utilizes the x y scanner 223 to createstereoscopic images of the lens with only a single ccd camera 232.Optical images 211 of the eye 213 and in particular optical images ofthe natural lens 103 of the eye 213 are conveyed along a path 211. Thispath 211 follows the same path as the laser beam 210 from the naturallens 103 through the laser patient interface 207, the focusing optics224, the x y scanner 223 and the beam combiner 222. This combination ofFIG. 2A further comprises: a laser patient interface 207, with areference mark 212; and a light source 233, which could be for exampleuniform illumination, a slit illumination, or other structured lightsource designed to enhance 3-dimensional accuracy. The light source, inpart, provides illumination of the natural lens of the patient's eye forthe purposes of determining the 3-dimensional dimensional position ofthe lens. Thus, either stereoscopic images and/or the information fromthe camera are sent to a controller and/or computer (not shown in FIG.2A) for further processing and use in determining 3-dimensionalpositions of the lens. Stereo images may be generated by commanding thescanner to go to and pause at a nominal left position and thenelectronically trigger the camera and controller to capture and storethe left image; then command the scanner/camera/controller similarly tocapture and store right image. This sequence may be repeated in aperiodic manner. These left and right images can be processed by thecontroller to generate the position and shape of the lens. The left andright images can be displayed using a stereo video monitor. Cameraimages or stereo images may also be used to measure suture geometry andorientation in the patient's lens, which can be used to determine theparameters of suture based shot patterns and to align suture based shotpatterns to the patient's lens suture geometry and orientation. Thecombination illustrated in FIG. 2A provides 3-dimensional informationthat can be used to determine the shape of the lens, including theanterior and posterior surfaces thereof. This information can also beused to visualize the structure of the lens, including sutures.Moreover, the information about the lens obtained from the combinationof FIG. 2A can further be used in determining the laser shot pattern andlaser shot placement with respect to lens shape and/or structure.

FIG. 2 and FIG. 2A are block schematic diagrams and thus the relativepositions and spacing of the components illustrated therein are by wayof example. Accordingly, the relative placements of these componentswith respect to one another may be varied and all or some of theirfunctions and components may be combined.

FIGS. 4A-E illustrate the three branched or Y suture geometry in thecontext of the structures found in the fetal nucleus 415 of the lens.Thus, these figures provide a more detailed view of the structuresillustrated as layer 130, which encompasses layer 122 of FIG. 1A. InFIGS. 4 A-E the view of the inner layer of the lens is rotated stepwisefrom the posterior side FIG. 4A to the anterior side FIG. 4E of thelens. Thus, this layer of the lens has three posterior suture lines 401,402, and 403. This layer also has three anterior suture lines 412, 413and 414. The anterior suture lines are longer than the posterior suturelines and these lines are staggered when viewed along the anterior toposterior (AP) axis 411. The lens fibers, which form the layers of thenucleus, are shown by lines 404, it being understood that these are onlyillustrative lines and that in the actual natural layer of the lensthere would be many times more fibers present. To aid in illustratingthe structure and geometry of this layer of the nucleus representativefibers 405, 406, 407, 408, 409 and 410 have been exaggerated andindividually shaded in FIGS. 4A-E. Thus, as the view of the lens nucleusis rotated from posterior to anterior the positions of theserepresentative fibers, their relationship to each other, and theirrelationship to the suture lines is illustrated.

The length of the suture lines for the anterior side is approximately75% of the equatorial radius of the layer or shell in which they arefound. The length of the suture lines for the posterior side isapproximately 85% of the length of the corresponding anterior sutures,i.e., 64% of the equatorial radius of that shell.

The term—essentially follows—as used herein would describe therelationship of the shapes of the outer surface of the lens and thefetal nucleus 415. The fetal nucleus is a biconvex shape. The anteriorand posterior sides of the lens have different curvatures, with theanterior being flatter. These curvatures generally follow the curvatureof the cortex and the outer layer and general shape of the lens. Thus,the lens can be viewed as a stratified structure consisting of longcrescent fiber cells arranged end-to-end to form essentially concentricor nested shells.

As provided in greater detail in the following paragraphs and by way ofthe following examples, the present invention utilizes this and thefurther addressed geometry, structure and positioning of the lenslayers, fibers and suture lines to provide laser shot patterns forincreasing the accommodative amplitude of the lens. Although not beingbound by this theory, it is presently believed that it is the structure,positioning and geometry of the lens and lens fibers, in contrast to thematerial properties of the lens and lens fibers, that gives rise to lossof accommodative amplitude. Thus, these patterns are designed to alterand affect that structure, positioning and/or geometry to increaseaccommodative amplitude.

FIGS. 5A-C illustrates the six branched or star suture geometry in thecontext of the structure found in the infantile layer of the nucleus 515of the lens. Thus, these figures provide a more detailed view of thestructures illustrated as layer 124 of FIG. 1A. In FIGS. 5A-C the viewof the layer of the lens is rotated from the posterior side FIG. 5A to aside view FIG. 56 to the anterior side FIG. 5C. Thus, this layer of thenucleus has six posterior suture lines 501, 502, 503, 504, 505, and 506.This layer of the nucleus also has six anterior suture lines 509, 510,511, 512, 513, and 514. The anterior suture lines are longer than theposterior suture lines and these lines are staggered when viewed alongthe AP axis 508. The lens fibers, which form the layers of the nucleus,are shown by lines 507, it being understood that these are onlyillustrative lines and that in the actual natural layer of the lensthere would be many times more fibers present.

The shape of the outer surface of the lens essentially follows theinfantile nucleus 515, which is a biconvex shape. Thus, the anterior andposterior sides of this layer of the lens have different curvatures,with the anterior being flatter. These curvatures generally follow thecurvature of the cortex and the outer layer and general shape of thelens. These curvatures also generally follow the curvature of the fetalnucleus 415. Thus, the lens can be viewed as a stratified structureconsisting of long crescent fiber cells arranged end-to-end to formessentially concentric or nested shells, with the infantile nucleus 515having the fetal nucleus 415 nested within it. As development continuesthrough adolescence, additional fiber layers grow containing between 6and 9 sutures.

FIGS. 6A-C illustrates the nine branched or star suture geometry in thecontext of the structure found in the adolescent layer of the nucleus611 of the lens. Thus, these figures provide a more detailed view of thestructures illustrated as layer 126 of FIG. 1A. In FIGS. 6A-C the viewof the layer of the lens is rotated from the posterior side FIG. 6A to aside view FIG. 6B to the anterior side FIG. 6C. Thus, this layer of thenucleus has nine posterior suture lines 601, 602, 603, 604, 605, 606,607, 608 and 609. This layer of the nucleus also has nine anteriorsuture lines 612, 613, 614, 615, 616, 617, 618, 619 and 620. Theanterior suture lines are longer than the posterior suture lines andthese lines are staggered when viewed along the AP axis 610. The lensfibers, which form the layers of the nucleus, are shown by lines 621; itbeing understood that these are only illustrative lines, and that in theactual natural layer of the lens there would be many times more fiberspresent.

The outer surface of the cornea follows the adolescent nucleus 611,which is a biconvex shape. Thus, the anterior and posterior sides ofthis layer have different curvatures, with the anterior being flatter.These curvatures generally follow the curvature of the cortex and theouter layer and general shape of the lens. These curvatures alsogenerally follow the curvature of the fetal nucleus 415 and theinfantile nucleus 515, which are nested within the adolescent nucleus611. Thus, the lens can be viewed as a stratified structure consistingof long crescent fiber cells arranged end-to-end to form essentiallyconcentric or nested shells. As development continues through adulthood,additional fiber layers grow containing between 9 and 12 sutures.

FIGS. 7A-C illustrate the twelve branched or star suture geometry in thecontext of the structure found in the adult layer of the nucleus 713 ofthe lens. Thus, these figures provide a more detailed view of the adultlayer 128 depicted in FIG. 1A. In FIGS. 7A-C the view of the layer ofthe lens is rotated from the posterior side FIG. 7A to a side view FIG.7B to the anterior side FIG. 7C. Thus, the adult layer of the nucleushas twelve posterior suture lines 701, 702, 703, 704, 705, 706, 707,708, 709, 710, 711, and 712. This layer of the nucleus also has twelveanterior suture lines 714-725. The anterior suture lines are longer thanthe posterior suture lines and these lines are staggered when viewedalong the AP axis 726. The lens fibers, which form the layers of thenucleus, are shown by lines 728; it being understood that these are onlyillustrative lines, and that in the actual natural layer of the lensthere would be many times more fibers present.

The adult nucleus 713 is a biconvex shape that follows the outer surfaceof the lens. Thus, the anterior and posterior sides of this layer havedifferent curvatures, with the anterior being flatter. These curvaturesfollow the curvature of the cortex and the outer layer and shape of thelens. These curvatures also generally follow the curvature of theadolescent nucleus 611, the infantile nucleus 515 and the fetal nucleus415 and the embryonic nucleus, which are essentially concentric to andnested within the adult nucleus 611. Thus, the lens can be viewed as astratified structure consisting of long crescent fiber cells arrangedend to end to form essentially concentric or nested shells.

A subsequent adult layer having 15 sutures may also be present in someindividuals after age 40. This subsequent adult layer would be similarto the later adult layer 713 in general structure, with the recognitionthat the subsequent adult layer would have a geometry having moresutures and would encompass the later adult layer 713; and as such, thesubsequent adult layer would be the outermost layer of the nucleus andwould thus be the layer further from the center of the nucleus and thelayer that is youngest in age.

In general, the present invention provides for the delivery of the laserbeam in patterns that utilize, or are based at least in part on, thelens suture geometry and/or the curvature of the lens and/or the variouslayers within the nucleus; and/or the curvatures of the various layerswithin the nucleus; and/or the suture geometry of the various layerswithin the nucleus. As part of the present invention the concept ofmatching the curvature of the anterior ablations to the specificcurvature of the anterior capsule, while having a different curvaturefor posterior ablations, which in turn match the posterior curvature ofthe lens is provided. Anterior and posterior curvatures can be based onKuszak aged lens models, Burd's numeric modeling, Burd et al. VisionResearch 42 (2002) 2235-2251, or on specific lens measurements, such asthose that can be obtained from the means for determining the positionof the lens with respect to the laser. Thus, in general, these laserdelivery patterns are based in whole and/or in part on the mathematicalmodeling and actual observation data regarding the shape of the lens,the shape of the layers of the lens, the suture pattern, and theposition of the sutures and/or the geometry of the sutures.

Moreover, as set forth in greater detail, it is not necessary that thenatural suture lines of the lens or the natural placement of the layersof the lens be exactly replicated in the lens by the laser shot pattern.In fact, exact replication of these natural structures by a laser shotpattern, while within the scope of the invention, is not required, andpreferably is not necessary to achieve an increase in accommodativeamplitude. Instead, the present invention, in part, seeks to generallyemulate the natural lens geometry, structures and positioning and/orportions thereof, as well as build upon, modify and reposition suchnaturally occurring parameters through the use of the laser shotpatterns described herein.

Accordingly, laser beam delivery patterns that cut a series ofessentially concentric, i.e., nested, shells in the lens may beemployed. Preferably, the shells would essentially follow the anteriorand posterior curvature of the lens. Thus, creating in the lens a seriesof cuts which resemble the nucleus layers of FIGS. 4, 5, 6 and 7. Thesecuts may follow the same geometry, i.e., shape and distance from thecenter, of these layers or may follow only a part of that geometry. Oneexample of these shells is illustrated in FIG. 8, which provides a lens103, a first shell cut 801, a first shell 802, a second shell cut 803, asecond shell 804 and a third shell cut 805. The adult nucleus 128 andcortex 113 are also provided. Thus, the term shell refers to the lensmaterial and the term shell cut refers to the laser beam deliverypattern and consequently the placement of the laser beam shots in thelens in accordance with that pattern. More or less shell cuts, and thusshells may be utilized. Moreover, the cuts may be such that they ineffect create a complete shell, i.e., the shell and shell cutscompletely encompass a volume of lens material. The cuts may also besuch that less than a complete shell is formed. Thus, the creation ofpartial shells, by the use of partial shell cuts, may be employed. Suchpartial cuts would for example be only a portion of a shell e.g., theanterior quartile, the anterior half, the posterior quartile, stackedannular rings, staggered annular rings, and/or combinations thereof.Such partial shells and shell cuts may be any portion of a threedimensional form, including ellipsoid, spheroids and combinationsthereof as those terms are used in their broadest sense that in generalfollows the contours of the lens, capsule, cortex, nucleus, and/or thelayers of the lens including the layers of the nucleus. Moreover, theuse of complete and partial shells and shell cuts may be used in asingle lens. Thus, by way of illustration of this latter point, thefirst and second cuts 801 and 803 are annular cuts, while the third cutis a complete cut.

A further use of partial shells is to have the shape of the shellsfollow the geometry and/or placement of the suture lines. Thus, partialpie shaped shells are created, by use of partial pie shaped shell cuts.These cuts may be placed in between the suture lines at the variouslayers of the lens. These partial shells may follow the contour of thelens, i.e., have a curved shape, or they may be flatter and have a moreplanar shape or be flat. A further use of these pie shape shells andshell cuts would be to create these cuts in a suture like manner, butnot following the natural suture placement in the lens. Thus, a suturelike pattern of cuts is made in the lens, following the general geometryof the natural lens suture lines, but not their exact position in thelens. In addition to pie shaped cuts other shaped cuts may be employed,such as by way of illustration a series of ellipses, rectangular planesor squares.

A further use of partial shells and/or planar partial shells is tocreate a series of overlapping staggered partial shells by usingoverlapping staggered partial shell cuts. In this way essentiallycomplete and uninterrupted layers of lens material are disruptedcreating planar like sections of the lens that can slide one atop theother to thus increase accommodative amplitude. These partial shells canbe located directly atop each other, when viewed along the AP axis, orthey could be slightly staggered, completely staggered, or anycombination thereof.

In addition to the use of shells and partial shells, lines can also becut into the lens. These lines can follow the geometry and/or geometryand position of the various natural suture lines. Thus, a laser shotpattern is provided that places shots in the geometry of one or more ofthe natural suture lines of one or more of the various natural layers ofthe lens as shown in FIGS. 4, 5, 6, and 7, as well as in the 15 sutureline layer, or it may follow any of the other patterns in the continuumof layers in the lens. These shot patterns can follow the generalgeometry of the natural suture lines, i.e., a series of star shapes withthe number of legs in each star increasing as their placement moves awayfrom the center of the lens. These star shaped shot patterns may followthe precise geometry of the natural suture patterns of the layers of thelens; or it can follow the exact geometry and placement of the sutures,at the same distances as found in the natural lens or as determined bymodeling of the natural lens. In all of these utilizations of starpatterns one or more stars may be cut. The length of the lines of thelegs of the star may be longer, shorter or the same length as thenatural suture lines. Moreover, if the length is shorter than thenatural length of the suture lines, it may be placed toward the centerof the star shape, i.e. the point where the lines join each other, ortowards the end of the suture line, i.e., the point furthest on thesuture line from the joining point. Further, if the cut is towards theend of the suture line it may extend beyond the suture line or may beco-terminus therewith. Moreover, partial star shaped cuts can be used,such as cuts having a “V” shape, or vertical or horizontal or at anangle in between. These linear cuts, discussed above, are in generalreferred to herein as laser created suture lines. Moreover, lasercreated suture lines may be grouped together to in effect form a shellor partial shell.

At present, it is theorized that the use of cuts near the end of thesuture lines will have the greatest effect on increasing accommodativeamplitude because it is believed that the ends of fibers near theanterior and posterior poles (the point where the AP axis intersects thelens) of the lens are more free to move then the portions of fibers nearthe equator where there is a greater number of gap junctions which bindfiber faces. At present, it is postulated that it is approximately thelast 15% of the fiber length that is most free in the youthful lens withhigh accommodative amplitude. It is further theorized that fiber layerstend to become bound with age due to a combination of increase insurface roughness and compaction due to growth of fiber layers above.Thus, as illustrated in FIG. 3 a shot pattern 301 is provided to ananterior portion of a layer 302 of the lens. This shot pattern 301 has acontour 303 that follows the contour of approximately the last 15% offiber length of fibers, represented by lines 304. Thus, the shell cutresembles the shape of a flower. Additionally, the number of petals inthe flower shaped shell should correspond to the number of suture lines305 at that growth layer. Thus, it is theorized that this partial shellcut and/or cuts will have the effect of unbinding the layers andreturning the lens to a more youthful increased amplitude ofaccommodation. Similarly, using partial shells, annular partial shellsor planar partial shells in this general area, i.e., the general area ator near the ends of the suture lines, may be employed for the samereasons. This theory is put forward for the purposes of providingfurther teaching and to advancing the art. This theory, however, is notneeded to practice the invention; and the invention and the claimsherein are not bound by or restricted by or to this theory.

The use of laser created suture lines, including star shaped patternsmay also be used in conjunction with shells, partial shells and planarpartial shells. With a particular laser shot pattern, or series of shotpatterns, employing elements of each of these shapes. These patterns maybe based upon the geometry shown in FIGS. 4-7 as well as the 15 sutureline geometry discussed herein; they may follow that geometry exactly,in whole or in part; and/or they may follow that geometry, in whole orin part, as well as following the position of that geometry in the lens.Although a maximum of 15 suture lines is known in the natural lens, morethan 15 laser created suture lines may be employed. Moreover, asprovided herein, the lens has multiple layers with a continuum of suturelines ranging from 3 to 15 and thus, this invention is not limited tothe suture patents of FIGS. 4-7, but instead covers any number of suturelines from 3 to 15, including fractions thereof.

The delivery of shot patterns for the removal of lens material isfurther provided. A shot pattern that cuts the lens into small cubes,which cubes can then be removed from the lens capsule is provided. Thecubes can range in size from a side having a length of about 100 μm toabout 4 mm, with about 500 μm to 2 mm being a preferred size.Additionally, this invention is not limited to the formation of cubesand other volumetric shapes of similar general size may be employed. Ina further embodiment the laser is also used to create a small opening,capsulorhexis, in the lens anterior surface of the lens capsule forremoval of the sectioned cubes. Thus, this procedure may be used totreat cataracts. This procedure may also be used to remove a lens havingopacification that has not progressed to the point of being cataractous.This procedure may further be used to remove a natural lens that isclear, but which has lost its ability to accommodate. In all of theabove scenarios, it being understood that upon removal of the lensmaterial the lens capsule would subsequently house a suitablereplacement, such as an IOL, accommodative IOL, or synthetic lensrefilling materials. Moreover, the size and the shape of thecapsulorhexis is variable and precisely controlled and preferably is in2 mm or less diameter for lens refilling applications and about 5 mm forIOLs. A further implementation of the procedure to provide acapsulorhexis is to provide only a partially annular cut and thus leavea portion of the capsule attached to the lens creating a hinged flaplike structure. Thus, this procedure may be used to treat cataracts.

It is further provided that volumetric removal of the lens can beperformed to correct refractive errors in the eye, such as myopia,hyperopia and astigmatism. Thus, the laser shot pattern is such that aselected volume and/or shape of lens material is removed byphotodisruption from the lens. This removal has the affect ofalternating the lens shape and thus reducing and/or correcting therefractive error. Volumetric removal of lens tissue can be preformed inconjunction with the various shot patterns provided for increasingaccommodative amplitude. In this manner both presbyopia and refractiveerror can be addressed by the same shot pattern and/or series of shotpatterns. The volumetric removal of lens tissue finds furtherapplication in enhancing corrective errors for patients that have hadprior corneal laser visions correction, such as LASIK, and/or who havecorneas that are too thin or weak to have laser corneal surgery.

In all of the laser shot patterns provided herein it is preferred thatthe laser shot patterns generally follow the shape of the lens andplacement of individual shots with respect to adjacent shots in thepattern are sufficiently close enough to each other, such that when thepattern is complete a sufficiently continuous layer and/or line and/orvolume of lens material has been removed; resulting in a structuralchange affecting accommodative amplitude and/or refractive error and/orthe removal of lens material from the capsule. Shot spacing of lesser orgreater distances are contemplated herein and include overlap asnecessary to obtain the desired results. Shot spacing considerationsinclude gas bubble dissipation, volume removal efficiency, sequencingefficiency, scanner performance, and cleaving efficiency among others.For example, by way of illustration, for a 5 μm size spot with an energysufficient to cause photodisruption, a spacing of 20 μm or greaterresults in individual gas bubbles, which are not coalesced and dissipatemore quickly, than with close shot spaces with the same energy, whichresult in gas bubble coalescence. As the shot spacing gets closertogether volume efficiency increases. As shot spacing gets closertogether bubble coalescence also increases. Further, there comes a pointwhere the shot spacing becomes so close that volume efficiencydramatically decreases. For example, by way of illustration, for a 450femtosecond pulse width and 2 microjoules energy and about a 5 μm spotsize with a 10 μm separation results in cleaving of transparent oculartissue. As used herein, the term cleaving means to substantiallyseparate the tissue. Moreover, the forgoing shot spacing considerationsare interrelated to a lesser or greater extent and one of skill in theart will know how to evaluate these conditions based upon the teachingsof the present disclosure to accomplish the objectives herein. Finally,it is contemplated that the placement of individual shots with respectto adjacent shots in the pattern may in general be such that they are asclose as possible, typically limited by the size and time frame ofphotodisruption physics, which would include among other things gasbubble expansion of the previous shot. As used herein, the time frame ofphotodisruptive physics refers to the effects that take placesurrounding photodisruption, such as plasma formation and expansion,shock waive propagation, and gas bubble expansion and contraction. Thus,the timing of sequential pulses such that they are timed faster thansome of, elements of, or all of those effects, can increase volumetricremoval and/or cleaving efficiency. Accordingly, we propose using pulserepetition frequencies from 50 MHz to 5 GHz., which could beaccomplished by a laser with the following parameters: a mode lock laserof cavity length from 3 meters to 3 cm. Such high PRF lasers can moreeasily produce multiple pulses overlapping a location allowing for alower energy per pulse to achieve photodisruption.

The terms first, second, third, etc. as used herein are relative termsand must be viewed in the context in which they are used. They do notrelate to timing, unless specifically referred to as such. Thus, a firstcut may be made after a second cut. In general, it is preferred to firelaser shots in general from posterior points in the laser pattern toanterior points, to avoid and/or minimize the effect of the gas bubblesresulting from prior laser shots. However, because of the varied lasershot patterns that are provided herein, it is not a requirement that astrict posterior to anterior shot sequence be followed. Moreover, in thecase of cataracts it may be advantageous to shoot from anterior toposterior, because of the inability of the laser to penetratesubstantially beyond the cataract.

Without further elaboration, it is believed that one skilled in the artcan, using the preceding description, utilize the present invention toits fullest extent. The following specific embodiments are, therefore,provided as examples of the invention and should be construed as beingmerely illustrating and not limiting the scope of the invention or thedisclosure herein in any way whatsoever.

The following examples are based upon measured lens data and lens datathat is obtained by using Burd modeling, which model is set forth inBurd et al., Numerical modeling of the accommodating lens, VisionsResearch 42 (2002) 2235-2251. The Burd model provides the followingalgorithm for anterior and/or posterior shape:

Z=aR ⁵ +bR ⁴ +cR ³ +dR ² +f

The coefficients for this algorithm are set forth in Table II.

TABLE II a b c d f Anterior (11-year) −0.00048433393427 0.00528772036011−0.01383693844808 −0.07352941176471 2.18 Posterior (11-year)0.00300182571400 −0.02576464843559 0.06916082660799 0.08928571428571−2.13 Anterior (29-year) −0.00153004454939 0.01191111565048−0.02032562095557 −0.07692307692308 2.04 Posterior (29-year)0.00375558685672 −0.03036516318799 0.06955483582257 0.09433962264151−2.09 Anterior (45-year) −0.00026524088453 0.00449862869630−0.01657250977510 −0.06578947368421 2.42 Posterior (45-year)0.00266482873720 −0.02666997217562 0.08467905191557 0.06172839506173−2.42

Additionally, the variables Z and R are defined by the drawing FIG. 9.

Thus, FIGS. 10, 11 and 12 provide cross sectional views of the lenshaving an outer surface 1001, 1101, 1201 for three ages, 18, 29 and45-year old respectively, based upon the Burd model and show growth insize along with shape changes with age. The units for the axes on thesedrawings, as well as for FIGS. 13, 23 and 24 are in millimeters (mm).

A combination of first cuts to create nested shells that in generalfollow the shape of and are positioned near the outer surface of thelens and second cuts to create a pattern directed toward the innerportions of the lens, with both the first cuts and the second cuts notcutting the material near the optical axis of the lens is provided. Thiscombination of cuts, with a central portion of the lens avoided,provides for both an increase in accommodative amplitude, as well as, anincrease in the refractive power of the lens. The first cuts can rangefrom one shell to many nested shells. They can be in the form of partialor complete shells, or a combination of both. In the case of partialshells they can be annular. The second cuts can be shells, cubes, orother patterns including combinations of horizontal and vertical cuts tocover a specific volume of material. The size of the area that is notcut by these patterns can range from a radius of about 0.1 mm to aradius about 2 mm, specifically from about 0.25 mm to about 1.5 mm, andmore specifically as set forth in the following examples. In addition tothe cylindrically shaped areas addressed above and in the examples,other shapes for this area may be utilized and would have widths fromabout 0.5 mm to about 4 mm, specifically from about 0.5 mm to about 3 mmand more specifically about 1 mm, about 2 mm and about 3 mm. Further,this radius or width can vary for different shells in the first cut andfor different locations of the second cuts. The use of the terms “first”and “second” in describing this combination of cuts is meant solely forthe purpose of identification of these cuts. These terms are notintended to and do not imply that one cut is made before or after theother. In fact, all sequences of making these cuts are contemplated.Additionally, it being readily understood that the shell cut is formedby and thus corresponds to a laser shot pattern. Specific examples ofsuch combinations of shot patterns are provided by way of illustrationin the following Examples 1-6, and are not meant to limit the scope ofsuch combinations.

EXAMPLE 1 provides for making of nested, lens shaped shell cuts incombination with cube shaped cuts. The laser shot patterns for thisexample are illustrated in FIG. 13. In this Figure there is shown theouter surface 1301 of a lens. There is further provided a series ofnested or essentially concentric shells and shell cuts, whichessentially follow the shape of the lens. Thus, there is providedannular shell cuts 1302, 1304, 1306, 1308, 1310, 1312, 1314, 1316, and1318. Shell cuts 1302 and 1304 are positioned nearer to and follow theanterior surface of the lens, while shell cuts 1316 and 1318 arepositioned nearer to and follow the posterior surface of the lens. Shellcuts 1306, 1308, 1310, 1312 and 1314 follow the entire curvature of thelens from anterior to posterior. The shell cuts form shells 1303, 1305,1307, 1309, 1311, 1313, 1315, and 1317. These shells and shell cuts formannular structures but are illustrated in FIG. 13 in cross-section. Assuch, the shells or cuts on the left side of the figure correspond to,and are part of, the shells or cuts shown on the right side of thefigure. These shells or partial shells are designed to increaseflexibility in the lens by decreasing the strength of nested fiberlayers by separating the bound layers, which it is theorized wouldreduce the structural strength and increase deflection for a given loador force.

There is further provided a second series of cuts in a cube pattern 1320of horizontal 1321 and vertical 1322 cuts. Shell cut 1314 borders and isjoined with cube cuts 1321 and 1322. Such a shell cut may be, but is notrequired to be present. Further, as provided in FIG. 13, both thesesecond cuts (cube cuts 1320) and the first cuts (shell cuts 1302, 1304,1306, 1308, 1310, 1312, 1314, 1316, and 1318) are removed away from theoptical axis of the lens by about 0.5 mm and thus form a cylinder ofuncut lens material 1350 that has a radius of about 0.5 mm (diameter ofabout 1 mm). Thus, there is shown in this figure a plurality of cuts andcube pattern that provide a series of annular cuts surrounding a centralportion of the lens that is not altered by the laser.

EXAMPLE 2 provides for making of nested, lens shaped shell cuts incombination with cube shaped cuts. The laser shot patterns for thisexample are illustrated in FIG. 14. In this Figure there is shown theouter surface 1401 of a lens. There is further provided a series ofnested or essentially concentric shells and shell cuts, whichessentially follow the shape of the lens. Thus, there is providedannular shell cuts 1402, 1404, 1406, 1408, 1410, 1412, 1414, 1416, and1418. Shell cuts 1402 and 1404 are positioned nearer to and follow theanterior surface of the lens, while shell cuts 1416 and 1418 arepositioned nearer to and follow the posterior surface of the lens. Shellcuts 1406, 1408, 1410, 1412 and 1414 follow the entire curvature of thelens from anterior to posterior. The shell cuts form shells 1403, 1405,1407, 1409, 1411, 1413, 1415, and 1417. These shells and shell cuts formannular structures but are illustrated in FIG. 14 in cross-section. Assuch, the shells or cuts on the left side of the figure correspond to,and are part of the shells or cuts shown on the right side of thefigure. These shells or partial shells are designed to increaseflexibility in the lens by decreasing the strength of nested fiberlayers by separating the bound layers, which it is theorized wouldreduce the structural strength and increase deflection for a given loador force.

There is further provided a second series of cuts in a cube pattern 1420of horizontal 1421 and vertical 1422 cuts. Shell cut 1414 borders and isjoined with cube cuts 1421 and 1422. Such a shell cut may be, but is notrequired to be present. Further, as provided in FIG. 14, both thesesecond cuts (cube cuts 1420) and the first cuts (shell cuts 1402, 1404,1406, 1408, 1410, 1412, 1414, 1416, and 1418) are removed away from theoptical axis of the lens by about 1 mm and thus form a cylinder of uncutlens material 1450 that has a radius of about 1 mm (diameter of about 2mm). Thus, there is shown in this figure a plurality of cuts and cubepattern that provide a series of annular cuts surrounding a centralportion of the lens that is not altered by the laser.

EXAMPLE 3 provides for making of nested, lens shaped shell cuts incombination with cube shaped cuts. The laser shot patterns for thisexample are illustrated in FIG. 15 In this Figure there is shown theouter surface 1501 of a lens. There is further provided a series ofnested or essentially concentric shells and shell cuts, whichessentially follow the shape of the lens. Thus, there is providedannular shell cuts 1502, 1504, 1506, 1508, 1510, 1512, 1514, 1516, and1518. Shell cuts 1502 and 1504 are positioned nearer to and follow theanterior surface of the lens, while shell cuts 1516 and 1518 arepositioned nearer to and follow the posterior surface of the lens. Shellcuts 1506, 1508, 1510, 1512 and 1514 follow the entire curvature of thelens from anterior to posterior. The shell cuts form shells 1503, 1505,1507, 1509, 1511, 1513, 1515, and 1517. These shells and shell cuts formannular structures but are illustrated in FIG. 15 in cross-section. Assuch, the shells or cuts on the left side of the figure correspond to,and are part of the shells or cuts shown on the right side of thefigure. These shells or partial shells are designed to increaseflexibility in the lens by decreasing the strength of nested fiberlayers by separating the bound layers, which it is theorized wouldreduce the structural strength and increase deflection for a given loador force.

There is further provided a second series of cuts in a cube pattern 1520of horizontal 1521 and vertical 1522 cuts. Shell cut 1514 borders and isjoined with cube cuts 1521 and 1522. Such a shell cut may be, but is notrequired to be present. Further, as provided in FIG. 15, both thesesecond cuts (cube cuts 1520) and the first cuts (shell cuts 1502, 1504,1506, 1508, 1510, 1512, 1514, 1516, and 1518) are removed away from theoptical axis of the lens by about 1.5 mm and thus form a cylinder ofuncut lens material 1550 that has a radius of about 1.5 mm (diameter ofabout 3 mm). Thus, there is shown in this figure a plurality of cuts andcube pattern that provide a series of annular cuts surrounding a centralportion of the lens that is not altered by the laser.

EXAMPLE 4 provides for making of nested, lens shaped shell cuts incombination with cube shaped cuts. The laser shot patterns for thisexample are illustrated in FIG. 16 In this Figure there is shown theouter surface 1601 of a lens. There is further provided a series ofnested or essentially concentric shells and shell cuts, whichessentially follow the shape of the lens. Thus, there is providedannular shell cuts 1602, 1604, 1606, 1608, 1610, 1612, 1614, 1616, and1618. Shell cuts 1602 and 1604 are positioned nearer to and follow theanterior surface of the lens, while shell cuts 1616 and 1618 arepositioned nearer to and follow the posterior surface of the lens. Shellcuts 1606, 1608, 1610, 1612 and 1614 follow the entire curvature of thelens from anterior to posterior. The shell cuts form shells 1603, 1605,1607, 1609, 1611, 1613, 1615, 1617 and 1619. These shells and shell cutsform annular structures but are illustrated in FIG. 16 in cross-section.As such, the shells or cuts on the left side of the figure correspondto, and are part of the shells or cuts shown on the right side of thefigure. These shells or partial shells are designed to increaseflexibility in the lens by decreasing the strength of nested fiberlayers by separating the bound layers, which it is theorized wouldreduce the structural strength and increase deflection for a given loador force.

There is further provided a second series of cuts in a shell pattern1620 of nested or essentially concentric shell cuts 1622, 1624, 1626,1628, 1630 and 1632 which form shells 1623, 1625, 1627, 1629 and 1631.Further, as provided in FIG. 16, both these second cuts 1620 and thefirst cuts (shell cuts 1602, 1604, 1606, 1608, 1610, 1612, 1614, 1616,and 1618) are removed away from the optical axis of the lens. In thisexample, by varying the distance from about 0.25 mm for cuts 1620 andfrom about 0.75 mm to about 2 mm for cuts 1602 et. seq., there isprovided a way to form a cylindrical like area of uncut lens material1650. This area of uncut lens material has a portion of essentiallyuniform radius 1652 (note that inner cut 1632 is arcuate) of about 0.25mm (diameter of about 0.5 mm) and a portion having a changing radius1651, varying from a radius of about 0.75 mm (diameter of about 1.5 mm)for cut 1616 to about 2 mm (diameter of about 4 mm) for cut 1614. In thearea of changing radius 1651 it can be seen that the change inradius/cut in this example is non-linear, with cut 1602 having a radiusof about 0.75 mm, cut 1604 having a radius of about 1 mm, cut 1606having a radius of about 1.25 mm, cut 1608 having a radius of about 1.4mm, cut 1610 having a radius of about 1.6 mm, cut 1612 having a radiusof about 1.7 mm, and cut 1614 having a radius of about 1.8 mm. Thus,there is shown in this figure a plurality of cuts that provide a seriesof annular cuts surrounding a central portion of the lens that is notaltered by the laser.

EXAMPLE 5, provides for making of nested, lens shaped shell cuts incombination with cube shaped cuts. The laser shot patterns for thisexample are illustrated in FIG. 17. In this Figure there is shown theouter surface 1701 of a lens. There is further provided a series ofnested or essentially concentric shells and shell cuts, whichessentially follow the shape of the lens. Thus, there is providedannular shell cuts 1702, 1704, 1706, 1708, 1710, 1712, and 1714, whichfollow the anterior shape of the lens. There is further provided aseries of nested or essentially concentric shell cuts, collectively,1716, which follow the posterior surface of the lens, and but for thedifference in shape of the posterior and anterior surface of the lens,are essentially mirror images of cuts 1702 et. seq. None of the shellcuts 1702 et. seq. or 1716 follow the entire curvature of the lens fromanterior to posterior. The shell cuts form shells 1703, 1705, 1707,1709, 1711, 1713, 1715, and 1717 and, collectively, 1717. These shellsand shell cuts form annular structures but are illustrated in FIG. 17 incross-section. As such, the shells or cuts on the left side of thefigure correspond to, and are part of the shells or cuts shown on theright side of the figure. These shells or partial shells are designed toincrease flexibility in the lens by decreasing the strength of nestedfiber layers by separating the bound layers, which it is theorized wouldreduce the structural strength and increase deflection for a given loador force.

There is further provided a second series of cuts in a shell pattern1720 of nested or essentially concentric shell cuts 1722, 1724, 1726,1728, 1730, 1732 and 1734, which form shells 1723, 1725, 1727, 1729,1731 and 1733. Further, as provided in FIG. 17, both these second cuts1720 and the first cuts (shell cuts 1702, 1704, 1706, 1708, 1710, 1712,1714 and 1716) are removed away from the optical axis of the lens. Thereis provided a cylindrical like area of uncut lens material 1750. Thisarea of uncut lens material has a portion of essentially uniform radius1752 (note that inner cut 1734 is arcuate) of about 0.25 mm (diameter ofabout 0.5 mm) and a portion having a changing radius 1751. Thus, thereis shown in this figure a plurality of cuts that provide a series ofannular cuts surrounding a central portion of the lens that is notaltered by the laser.

EXAMPLE 6 provides for making of nested, lens shaped shell cuts incombination with cube shaped cuts. The laser shot patterns for thisexample are illustrated in FIG. 18 In this Figure there is shown theouter surface 1801 of a lens. There is further provided a first seriesof nested or essentially concentric shells and shell cuts, whichessentially follow the shape of the lens. Thus, there is providedannular shell cuts collectively 1802 and 1804. Cuts 1802 follow theanterior shape of the lens. Cuts 1804 follow the posterior surface ofthe lens. None of these shell cuts 1802, 1804, follow the entirecurvature of the lens from anterior to posterior. These shell cuts formshells (shown but not numbered). These shells and shell cuts formannular structures but are illustrated in FIG. 18 in cross-section. Assuch, the shells or cuts on the left side of the figure correspond to,and are part of the shells or cuts shown on the right side of thefigure. These shells or partial shells are designed to increaseflexibility in the lens by decreasing the strength of nested fiberlayers by separating the bound layers, which it is theorized wouldreduce the structural strength and increase deflection for a given loador force.

There is further provided a second series of cuts in a pattern of nestedor essentially concentric shell cuts, collectively 1820, which formshells (shown but not numbered). Further, as provided in FIG. 18, boththese second cuts 1820 and the first cuts 1802, 1804 are removed awayfrom the optical axis of the lens. There is provided a cylindrical likearea of uncut lens material 1750. This area of uncut lens material has aportion of essentially uniform radius 1752 (note that the inner most cutis arcuate) and portions having varying or changing radii 1851, 1853. Inthis example, the change in radius is different between the posterior1851 and anterior 1853 sides. Further, the outer radii for these cuts18002, 1804, varies and in this example is different for the anteriorand posterior side cuts. Thus, there is shown in this figure a pluralityof cuts that provide a series of annular cuts surrounding a centralportion of the lens that is not altered by the laser.

Various combinations of first and second shell cuts can be employed.Thus, the first and second patterns of any of Examples 1 through 6 maybe used with any of the other first and second patterns of thoseexamples. Similarly, any of these patterns may also be used inconjunction with the other patterns and teachings of patterns providedin this specification, including the patterns that are incorporatedherein by reference. Moreover, when utilizing the teachings of theseexamples regarding varying or changing radii for uncut areas, the changein those radii per cut can be uniform, non-uniform, linear ornon-linear. Moreover, such changes in radii per cut for either or boththe interior radii (closest to the optical axis of the eye) or the outerradii can be the same from the anterior to the posterior side or thechanges can be different from the anterior to posterior side cuts.

Although not bound by this theory, it theorized that increasing thedeflection of the lens for a given load or zonule force will increasethe flexibility of the lens structure and, in turn, the amplitude ofaccommodation for that same zonule force. Further, it is theorized thatby providing these annular shells in conjunction with the cylindricalcuts and unaffected center portion of the lens, for example 1350, 1450,1550, 1650, 1750, and 1850, that the shape of the lens will be alteredin a manner that provides for an increase in the refractive power of thelens. Thus, the combination of these first and second cuts provides forboth improved accommodative amplitude and increased refractive power ofthe lens.

A further application of laser shot patterns is to create an area ofopacification in the lens, which opacification functions to provide alimiting aperture in the lens, which limiting aperture is smaller thanthe dark adapted pupil diameter. Use of a limiting aperture in thevisual system improves depth of field, depth of focus and image quality.Thus, It is believed that creating such a limiting aperture within thelens will provide these benefits and may for example assist in theability to see and read printed materials. Moreover, it is believed thatthe creation of such a limiting aperture can be combined with thecreation of other cuts and structures within the lens, which cuts andstructures are for the purpose of increasing refractive power andimproving accommodative amplitude, as taught for example in thisspecification and the pending specifications that are incorporatedherein by reference. Thus, it is believe that this combination oflimiting apertures and other structures will have an additive effect toimproving vision and especially near vision.

Such a limiting aperture would be provided by the creation of an annulusof opacified lens material. The inner diameter for this annulus ofopacified material would be between about 1 to about 4 mm and theoutside diameter would be between about 4 to about 7 mm. The degree ofopacification in the annulus is not necessarily 100% blocking, but mustbe blocking enough to reduce negative visual symptoms. Thus, forexample, about 90%, about 80%, from about 20% to about 100%, and morespecifically from about 50% to about 100% opacification within theannulus, as measures by the amount of light blocked, i.e. 100% minus thetransmission percentage, are provided. This opacified annulus ispositioned essentially central to the optical axis of the lens oressentially central to the natural pupil. Additionally, the limitingaperture may be located at any point between the anterior and posteriorsurfaces of the lens. To create such an opacified annulus in the lensthe laser parameters would be chosen to have sufficient excess energy orenergy density, when compared with that which is required for meetingminimum photo disruption threshold, to cause the lens material to retaina degree of opacification. Moreover, by way of example, other sources ofexcess energy, including thermal energy, for the creation of theopacified lens aperture may be obtained by choosing lasers with longerpulse widths, including but not limited to, those that extend tocontinuous wave operation.

Examples 7 to 9 provide for combinations of limiting apertures, shellsand other structures for the proposes of improving accommodativeamplitude and increased refractive power. Thus, Example 7, which isillustrated in FIG. 19, provides for a limiting aperture 1902, having adiameter of about 2 mm (radius of about 1 mm), that is located near tothe anterior lens surface 1901, as well as, other structures 1903. Thelimiting aperture 1902 is provided by an opacified annulus 1904, havingan outer diameter of about 7 mm.

Example 8, which is illustrated in FIG. 20, provides for a limitingaperture 2002, having a diameter of about 2 mm that is located centralto the lens surface 2001 (i.e., between the anterior and posteriorsurfaces of the lens), as well as, other structures 2003. The limitingaperture 2002 is provided by an opacified annulus 2004, having an outerdiameter of about 4.5 mm.

Example 9, which is illustrated in FIG. 21, provides for a limitingaperture 2102, having a diameter of 1.5 mm, that is located near theposterior of the lens surface 2101, as well as other structures 2103.The limiting aperture 2102 is provided by an opacified annulus 2104,having an outer diameter of about 6 mm.

It should further be understood that although the limiting apertures areshown in combination with other structures they can also be used withoutthe presence of those structures. Moreover, although the limitingapertures in these examples are shown as having a smaller inner diameterthan the other structures, it should be understood that the innerdiameter of some or all of the other structures could be smaller thanthe inner diameter of the limiting aperture, as these other structuresare not opacified. Further, the opacification of the annulus maydecrease over time. Thus, retreatment of the lens many be periodicallyrequired to maintain the benefits set forth above.

There is further provided the use of substantially vertical shotpatterns, that is shot patterns that have cuts that are essentiallyparallel to the Optical axis of the eye. Thus, Example 10, which isillustrated in FIG. 23, provides an outer surface 2301 of a lens thathas a shot pattern that has vertical cuts, e.g., 2302, arranged in apattern that provides for an annular area of cutting 2303. These figuresare show in cross-section and thus the pattern on the right sidecorresponds to the pattern on the left side. Moreover, as such thedensity of vertical cut is the same on the left and right side of thefigures.

Example 11, which is illustrated in FIG. 24 provides a further exampleof the use of vertical cuts. In this example there is provided an outersurface 2401 of the lens that has a shot pattern that has vertical cuts,e.g., 2402, arranged in a pattern that provides for an annular area ofcutting 2403. These figures are show in cross-section and thus thepattern on the right side corresponds to the pattern on the left side.Moreover, as such the density of vertical cut is the same on the leftand right side of the figures. As illustrated, the density of thevertical cuts in Example 11 is substantially greater than the density ofshots in Example 10.

The vertical cuts can be separately spaced from each other in theannular area, thus creating a series of parallel disconnected verticalcuts, they can be positioned close enough together to create a series ofconcentric vertical cylinders.

The inner diameter of the annular area of cutting when using suchvertical cuts as illustrated in Examples 10 and 11 is from about 0.5 mmto about 2.5 mm and the outer diameter of such vertical cuts is fromabout 2 or 3 mm to about 7 or 8 mm.

The use of vertical shot patterns or primarily vertical shot patternshas added advantages in slower laser systems. In particular, the use ofvertical shot patterns has added advantages in laser systems slower thanF/# equals 1.5 (F/1.5), and in particular slower that F/2. Additionally,the ability to move the shots closer together, i.e., more dense, isobtainable with such vertical shot patterns. Thus, the spacing can besmaller than three times the spot size. Accordingly, fully cleavedhorizontal lens sections have been made by using shot densities smallthat were smaller than three times the spot size, e.g., about 10-20 μmseparation for a 10 μm spot.

A coherent optical effect occurs when coherent superposition of opticalwaves with constructive and destructive interference takes place.Rainbow glare is an example of a coherent optical effect. Such effectscan arise when highly regular and spatially periodic optical featuresare present within an optical system. Thus, to prevent these effectsfrom occurring in the eye as a result of the various cutting of lenstissue described in this specification and the applications that areincorporated herein by reference, it is provided that random orirregular shot spacings be incorporated partially or completelythroughout the shot patterns. Thus, for example and by way ofillustration, multiple successive layers of regularly shaped shots canbe offset by a factor of a number smaller than the shot spacing, andwhich is not an integral multiple of the spacing, over four. Moreover,such multiple layers can be purely random such that there is noidentifiable pattern. Such randomness or irregularity should besufficient to prevent the superposition of optical waives, and thus,prevent constructive and destructive interference from taking place.

In the Examples and in the teachings provided in this specification, thespacing and number of cuts are provided by way of illustration and arenot limiting. Thus, it is understood that the size of the cubes can varyfrom the 0.25 mm shown and can be from about 10 μm to about 2.5 mm.Similarly the spacing and number of shell cuts can vary from that shownin the Figures corresponding to the Examples 1 through 6. As few as onesuch shell cut to as many as about 100 may be used, with their spacingbeing either uniform or varied. Further the distance between the shellcuts and the cube cuts or second shell cuts can vary from that shown inthese Figures. For the closer spaced cuts, as well as, for the largernumber of cuts smaller spot sizes for the focused laser are preferred.For example, an optical system of F/# (i.e., the ratio of the focallength to the beam diameter) equals 1.5 can produce spot size on theorder of 3 μm and a Rayleigh range equal to +/−10 μm at a wavelength of1 μm, which can be utilized to create more shell cuts, such as forexample about 100 shell cuts. Such a spot size can also be utilized forsmaller size cubes, such as down to about 10 μm. Although the smallersize spots may also be used for the other combinations of cuts providedby these examples. By way of further illustration an optical system ofF/# equals 4 can be used to create 10 to 20 shells.

For the shot patterns disclosed and taught in this specification, aswell as, those incorporated herein by reference, it may be advantageousfor the outer most dimension of the shot pattern to avoid living tissuein the lens.

In the lens of an eye there is located an Organelle rich zone which islocated in the fiber elongating region of the lens. In this region thefiber cells have a complete complement of organelles, including a cellnucleus. For example, in an approximately 50 year old lens the organellerich region would about 250 μm from the equator tapering to about100-150 μm at the poles (about 100 μm at the anterior pole and about 150μm at the posterior pole).

Moving inward from the outer surface of the lens, there is a regionhaving less organelles, which is referred to as the organelledegradation region. This region overlaps to some extent with the innerportion of the organelle rich zone. In this zone the organelles arebeing degraded or eliminated. The fibers are actively eliminating theorganelles including the nucleus. For example, in an approximately 50year old lens the degradation region would extend from the organellerich zone to about 300 μm from the equator tapering to about 125-200 μmat the poles (about 125 μm at the anterior pole and about 200 μm at theposterior pole).

Moving inward from the outer surface of the lens, there is a regionhaving essentially no organelles, which is refereed to as the organellefree zone. This region would be located inward of the degradation regionand would overlap with this region to some extent. The fibers in theorganelle free region would be denucleated and the material in thisregion of the lens would be considered denucleated.

The laser shot pattern can be such that no shots, or at a minimumessentially no shots, are place in the organelle rich zone. Further theshot pattern can be such that no shots, or at a minimum essentially noshots, are placed on the organelle degradation zone. Thus, as one way toavoid directing the laser to the living tissue of a lens it is providedby way of example that the shot pattern should be about a 0.4 mm orgreater inset away from all the outer surfaces of the lens. Thus, by wayof example, the laser pulses so directed would be on lens material thatis denucleated. By way of further example the shot pattern should berestricted to a region that is inset about 0.3 mm from the surface atequator tapering to an inset that is about 0.125 mm at the surface bythe anterior pole and an inset that is about 0.2 mm from the surface atthe posterior pole.

A further parameter in obtaining optimal performance of the laser andlaser shot pattern can be obtained by using the laser to provide veryfast multiple pluses, in effect, a rapid burst of pulses to essentiallyon spot in the pattern. This implementation provides the dual advantagesof reduced Rayleigh ranges through the use of lower energy pulses, whilealso increasing the probability of achieving photodisruption, which hasalso been referred to as Laser Induced Optical Breakdown (LIOB).Previously, it is believed that the ability to reduced Rayleigh rangeeffects through lower energy pulses resulted in a decrease of theprobability of achieving LIOB.

For example, a laser such as the Lumera Rapid Laser oscillator/amplifiercan provide either one pulse of 20 μJ at a 50 kHz rate or a series of,or burst of, 2 to 20 pulses, with each pulse in the burst beingseparated by 20 nanoseconds, due to the 50 MHz laser oscillator. Thus,the burst can be delivered such that the total energy in the burst isapproximately 20 μJ. For example, a burst of 4 pulses would haveapproximately 5 μJ per pulse and the rate at which each burst occurswould be 50 kHz.

Referring to FIG. 22 there is provided an illustration that shows acomparison of single higher energy laser pulse with bursts of lowerenergy laser pulses over time. Accordingly, there is provided a singlelaser pulse 2271 (shown in dashed lines for illustration purposes only)having an energy of 20 μJ and another singe laser pulse 2272 (shown indashed lines for illustration purposes only) having an energy of 20 μJ.The time shown by arrow 2292 between pulse 2271 and pulse 2272 is t₂.Thus, 2271 and 2272 represent the use of single 20 μJ pulses. If forexample t₂ is equal to 20 u sec (micro seconds) then the rate for thesepulses would be 50 kHz.

Still referring to FIG. 22 there is additionally shown burst 2200, 2210and 2220. These burst are each shown as being made up of four laserpulses. The use of four pulses is solely for the purposes ofillustration and is not meant to be and does not limit the amount ofpulses that may be utilized. Thus, burst 2200 is made up of pulses 2201,2202, 2203, and 2204; burst 2210 is made up of pulses 2211, 2212, 2213and 2214; and, burst 2220 is made up of pulses 2221, 2222, 2223 and2224. Each of the pulses in bursts 2200, 2210 and 2220 is 5 μJ. The timeshown by arrow 2291 is the time between each individual pulse, e.g.,2201 and 2202, in a burst, e.g., 2200 and is referred to herein as t₁.The time shown by arrow 2293 between the first pulses in sequentialbursts, e.g., 2201 and 2211, is t₃.

By way of example and for the purposes of illustration, it is providedthat for a scan rate of about 30 kHz to about 200 kHz, a t₃ of about 5μseconds to about 33 μseconds, and a t₁ of about 5 nanoseconds to about20 nanosecond may be utilized.

For a given optical spot size, the amount of energy required to exceedphotodisruption threshold might be 5 μJ. Rather then providing a singlepulse of 20 μJ to a spot in a shot pattern, a burst of 4, 5 μJ pulsescould be utilized, with each pulse in the burst being separated by about20 nanoseconds. The use of such a burst will tend to increase theprobability of achieving photodisruption threshold while also minimizingthe Rayleigh range effects of extending the tissue effect in the zdirection, or along the beam path. In this way the use of such burstsincrease the probability of achieving photodisruption, which has alsobeen referred to as Laser Induced Optical Breakdown (LIOB).

Accordingly, it is desirable to use energy densities in the regionaround LIOB threshold, i.e., the threshold at which photodisruptiontakes place, to minimize Rayleigh range effects. However, in thevicinity of LIOB threshold small and sometimes random variations intransmission, absorption, laser energy fluctuations, or optical spotsize variations due to for example optical aberrations, can prevent LIOBin an undesirable and random matter throughout the treatment field.Optical spot size variations due to for example optical aberrations areespecially found in low F/# systems.

It is further desirable to have complete treatment in any giventreatment field. Thus, for example, in the shot patterns provided hereinthe treatment filed would be all of the x y and z coordinates of thepattern. It is further, for particular applications and in particularhorizontal cuts, desirable to have laser energy densities in thevicinity of LIOB. Such energy densities minimize Rayleigh range effectsand thus minimize the about of material in the z direction that isremoved. However, by using such energy densities, and thus, obtainingthe benefit of minimized Rayleigh range effects, the undesirable andrandom prevention of LIOB, as discussed above in the precedingparagraph, can occur. Thus, to minimize Rayleigh range effect and avoidLIOB prevention, it is provided to use of a burst of closely spaced intime pulses, wherein each pulse within the burst is in the vicinity ofLIOB threshold. Through the use of such bursts the probability ofachieving LIOB threshold is increased compared to using a single pulsewith the same energy density.

Various other shot patterns are disclosed in greater detail in thespecifications incorporated herein by reference, and include suchconfigurations as cut horizontal partial planes whose extent is definedby a refractive shape. It is to be understood that as an alternative tohorizontal planes, vertical partial planes or other orientation cutswhose extent is defined by the refractive shape may be used. Methods andshot patterns for treating and removal of cataracts and/or for clearlens extractions may be employed. Thus, there is provided a method forthe structural modification of the lens material to make it easier toremove while potentially increasing the safety of the procedure byeliminating the high frequency ultrasonic energy used in Phacoemulsification today. In general, the use of photodissruption cutting ina specific shape patterns is utilized to carve up the lens material intotiny cube like structures small enough to be aspirated away with 1 to 2mm sized aspiration needles.

Moreover, a shot pattern to create 0.5 mm sized cubes out of the lensmaterial following the structural shape of a 45-year old Burd Model lensmay also be utilized. Thus, there is provided a shot pattern thatcreates grid like cuts, the end of which cuts essentially follows theshape of the lens. The sequence of laser shots in this pattern may beexecuted from posterior to anterior, as in most of the patternsdisclosed herein, to obtain more predictable results by reducing thevariation caused by shooting through gas bubbles. However, it may bedesirable to shoot cataracts from the anterior to the posterior for thepurpose of choosing the lesser of two undesirable effects. Thus, it maybe advantageous to shoot through the gas bubbles, or let them dissipate,rather then shooting through cataractus tissue, which much more severelyscatters the light and more quickly prevents photodissruption comparedto gas bubble interference. Accordingly, it is proposed to photodissruptthe most anterior sections of the cataract first, then moveposteriorally, shooting through gas bubble remnants of cataractoustissue, to the next layer of cataract tissue below. In addition toshooting the laser in anterior z planes then moving posterior, it isfurther provided to essentially drill down anterior to posterior, whichwe call the z axis throughout this document and then move in x/y anddrill down again.

Additionally, shot patterns that relate to gradient index modificationof the lens may be employed. Thus, it is provided to use thephotodissruptive laser in the creation of small voids within the lensfiber material which will then fill-in with aqueous humor fluid whichhas a lower index of refraction and, via area weighting or volumeweighting, decrease the net refractive index of a particular region.Accordingly, if different void densities are placed in nested shellvolumes, then this would diminish the average index of refraction ofessentially concentric regions in a similar manner to the youthful lens.Further, a gradient index modification, which has different voiddensities placed in nested volumes, may be employed. Thus, there isprovided a series of nested shot patterns with each pattern creating anincrementally different void density in the lens material. For example,if a nominal 25% weighting efficiency was obtained in the most denselytreated region, filling that volume with 1.38 index of aqueous humor,and the remaining region that was 75% lens material of index 1.42, thenthe average resultant index of refraction would be 0.25*1.38+0.75*1.42or 1.41, which we see from FIG. 31, that would restore the gradient fromthe center to a 2 mm radius, which is most central optical region forvisual function. Thus, a distributed regional treatment of increasingdensity from the center of the lens to the periphery of the lens may beemployed.

Shell patterns may also be employed that provide for cutting in relationto suture lines. Thus, cuts along either modeled suture lines, ormeasured suture lines may be used. The latter being provided by themeasuring of patient lens sutures with a CCD camera and aligning suturecuts to the measured locations of suture lines. Thus, the brightestsuture lines and or those with the widest spatial distribution likelybelong to the deepest layers, and perhaps the initial Y suture branchesfound in the fetal nucleus. Further, there it is provided to cut Ysuture shapes at the lowest layers in the lens and then increasing thenumber of cuts as the layers move out peripherally.

Further, sectional patterns may be employed. Such patterns would includethe cube patterns, variations in the shape and size of this cubepattern, concentric cylinders, radial planes, horizontal planes andvertical planes, partial shells and shells, and combinations thereof. Asused to describe these patterns, vertical refers to essentially parallelto the optical axis, i.e., the AP axis. These sectional patterns areemployed within, or to comprise, a particular shaped volume. Thus, thesesectional patterns can be used in shaped volumes that provide forpositive or negative refractive corrections. Further, these shapedpatterns can be used in shaped volumes that result in shaped structuralweakening, which causes shape change and results in a positive ornegative refractive correction. Additionally, shaped structuralweakening may also result in increased accommodative amplitude.

Moreover, these patterns can be employed in conjunction with each other,i.e., vertical and horizontal, or in isolation, i.e., only vertical orhorizontal, at various locations in the lens, which locations can rangefrom totally separate, to slightly overlapping, to overlapping.Additionally, by selectively arranging placement and density of thesepatterns and/or combination of primarily vertical and primarilyhorizontal patterns, local structure in the lens can be weakened byvarying and predetermined amounts, which can result in selectiveflexibility and shape changes. Thus, through such selective placementand density determinations shaped structural weakening may beaccomplished.

These sectional patterns may be employed using primarily vertical orprimarily horizontal patterns. Primarily vertical patterns, whichinclude vertical cylinders and vertical planes, may provide morecomplete cleaving than essentially horizontal patterns due to therelative long depth of field of a photo disruption spot compared to thenarrow width of the spot. Primarily horizontal patterns, such ashorizontal planes and shell cuts near the center of the lens, i.e,poles, may provide lesser structural weakening due to less completecleaving. Moreover, primarily horizontal patterns, such as shells cut tothe shape of the lens, will tend to preserve the overall shape of thelens, while still providing some structural weakening to improveflexibility.

In determining the particular types of structural patterns to use,greater structural weakening with less regard to preserving initialshape may be employed by providing primarily vertical patterns therein.Moreover still greater structural weakening with less regard topreserving initial shape may be employed by providing both primarilyvertical and primarily horizontal patterns therein. Further, indetermining the particular types of structural patterns to use, greaterstructural weakening with less regard to preserving initial shape may beemployed within the center of the lens, such as the compacted fetalnucleus by providing primarily vertical patterns therein. Moreover stillgreater structural weakening with less regard to preserving initialshape may be employed within the center of the lens, such as thecompacted fetal nucleus by providing both primarily vertical andprimarily horizontal patterns therein.

Optical performance and optical quality are dependent upon the surfaceshape and quality of the lens. Thus, to balance increasing accommodativeamplitude via increased flexibility with maintaining and/or obtaininglens shape for desired optical performance and optical quality variouscombinations, densities and placements of these patterns may beemployed. By way of illustration, a combination of central patterns andperipheral patterns may be utilized to maximize structural weakening andcontrol of lens shape. Thus, patterns can be selected for placement inthe center of the lens, such as the fetal and embryonic nucleus, whichwill result in maximum shaped structural weakening with minimal effecton lens surface shape changes, which surface effect is based essentiallyupon the placement of the pattern. In conjunction with this centralpattern more peripheral lens areas, such as the infantile, adolescentand adult nucleus and cortex, may be treated with primarily horizontalpatterns to increase flexibility yet maintain the shape of the lens.Moreover, these primarily horizontal patterns may be selected such as tochange the lens surface shape in a predetermined manner.

Additionally, the forgoing methods for increasing accommodativeamplitude, as well as other such methods, may result in an increase inrefractive error. Thus, as the accommodative amplitude is increased by adiopters range, a refractive error may be introduced into the lens,hereinafter referred to as an induced refractive error. This inducedrefractive error can be predicted and/or observed. This inducedrefractive error can be reduced, prevented, and/or minimized by thepredetermined placement of additional laser shots, either as part of theshot pattern for increasing accommodative amplitude or as a separateshot pattern. Additionally, this induced refractive error can beaddressed by any technique for correcting refractive error known tothose skilled in the art.

Generally, to correct for, prevent and/or minimize the effect of inducedrefractive error, after a laser procedure to increase accommodativeamplitude, shots are selected for the shot pattern to simultaneouscorrect refractive error while increasing accommodative amplitude.Further, these selected shots may provide shaped structural weakeningfor the purpose of refractive error change. Thus, these selected shotsto correct induced refractive error include modifications to the shapeof the pattern, modifications to the placement of the shots, and mayfurther include the same number of shots or a higher or lower number ofshots. For determining the selected shots the induced refractive errorcan be predicted, based upon modeling and/or prior testing andobservation.

Although less preferred, after the laser procedure to increaseaccommodative amplitude is preformed, the actual change in refraction ofthe eye may be determined through observation. Based upon this observedchange in refraction a corrective refractive procedure is selected tocorrect and/or minimize the observed change. This corrective refractiveprocedure may be a laser shot pattern provided to the lens, such as butnot limited to the refractive laser shot patterns provided herein. Thiscorrective refractive procedure may also be laser corrective procedurethat is directed towards the cornea, such as laser techniques known tothose skilled in the art for treating refractive errors throughmodification of corneal tissues, such as PRK and LASIK. In these cornealprocedures the laser for correcting induced refractive error may bedifferent from the laser used for the accommodative amplitude procedure.Additional corneal refractive procedures are known to those of skill inthe art and may be employed to address induced refractive error; suchprocedures included but are not limited to radial keratotomy andconductive keretoplasty. Moreover, the observed change in refraction maybe addressed by spectacles and/or contact lens.

The corrective refractive procedure may be performed shortly after theprocedure to increase accommodative amplitude. However, the correctiverefractive procedure may also be provided at longer periods of timeafter the accommodative amplitude procedure, including, days, weeks,months or longer.

The correction of induced refractive error may be further understood bythe following by the following illustrative and exemplary teaching.Prior to lens flexibility treatment, the patient's range ofaccommodation, will extend about a corrected distance vision of 0diopters. After lens flexibility treatment, the patient's range ofaccommodation will be substantially increased but the range will nowextend negatively from 0 to −β diopters. A second lens refractivetreatment is performed to shift the range positively by adding βdioptersof refractive power to the lens. In this way the range of the patient'saccommodation extends positively from 0 to β diopters

In any given patient population the flexibility power change will not be−β but instead will be distributed about a mean X_(flex) (which wedesign to be −β) with a variance of σ² _(flex). Similarly, therefractive power change will also not be β but will be distributed abouta mean X_(ref) (which we design to be β) with a variance of σ² _(ref).The outcome of the sum of both the flexibility and refractive powerchange will also be distributed about a mean of X_(flex)+X_(ref)=0 witha total standard deviation of sd_(total)=sqrt(σ² _(flex)+σ² _(ref)) fornormally distributed populations.

While it is desired that the sum of the flexibility power change and therefractive power change be 0, the normal range of these power changeswill result in some of the patients experiencing a range ofaccommodation that will extend not from 0 but from some positive value.This shift would be undesirable as it would require additionalrefractive correction to restore the patients nominal distance vision.These patients are in the population of patients whose total flexibilityand refractive power change is greater than the mean value of 0. Byshifting this distribution negatively away from 0 we can reduce thepercentage of patients needing further refractive correction.

To prevent the need for extra refractive correction, the magnitude ofthe refractive power cut is reduced from X_(ref) to X_(ref)−α×sd_(total)where α=1 results in 16%, α=2 results in 2.5%, and α=3 results in 0.15%of the patients experiencing accommodation ranges extending not from 0but from some positive value for normally distributed populations. Thisapproach minimizes the need for additional refractive correction byreducing the range of accommodation from β to β−α×sd_(total).

The components and their association to one another for systems that canperform, in whole or in part, these examples are set forth above indetail. Additionally, it is noted that the functions of the methods andsystems disclosed herein may be performed by a single device or byseveral devices in association with each other. Accordingly, based uponthese teachings a system for performing these examples, or parts ofthese examples, may include by way of illustration and withoutlimitation a laser, an optical system for delivering the laser beam, ascanner, a camera, an illumination source, and an applanator which hasreference marks thereon. These components are positioned so that whenthe eye is illuminated by the illumination source, light will travelfrom the eye through the applanator to the scanner. In this system theillumination source is movable with respect to the eye to providevarying angles by which the eye can be illuminated.

Similarly, such system may also include by way of example and withoutlimitation a laser, a system for determining the position and shape ofcomponents of an eye, a camera, a controller (which term refers to andincludes without limitation processors, microprocessors and/or othersuch types of computing devices that are known to those of skill in theart to have the capabilities necessary to operate such a system), anillumination source, and an eye interface device. In this system thescanner is optically associated with the eye interface device, such thatwhen the eye is illuminated by the illumination source, light willtravel from the eye through the eye interface device to the scanner. Thescanner is further optically associated with the camera, such that thescanner has the capability to provide stereo pairs of images of the eyeto the camera. The camera is associated with the controller and iscapable of providing digital images of the eye to the controller; and,the controller further has the capability to determine, based in partupon the digital images provided from the camera, the shape, positionand orientation of components of the eye.

Moreover, such systems may also include by way of example and withoutlimitation a system for delivering a laser to an eye. This system wouldhave a laser, a scanner, a camera, an illumination source, an eyeinterface device, a means for determining the shape and position ofcomponents within an eye and a means for directing the delivery of alaser beam from the laser to a precise three dimensional coordinate withrespect to the components of the eye, the means for directing thedelivery of the laser beam having the capability to direct the beambased at least in part on the determination of the shape and position ofcomponents within the eye by the determining means.

From the foregoing description, one skilled in the art can readilyascertain the essential characteristics of this invention, and withoutdeparting from the spirit and scope thereof, can make various changesand/or modifications of the invention to adapt it to various usages andconditions.

1-99. (canceled)
 100. A system for delivering a laser beam to a lens ofan eye in a plurality of patterns comprising: a) a laser; b) an opticalpath for directing a laser beam from the laser to the lens of the eye;c) a control system configured to direct the laser beam in a firstpattern on a first portion of the lens of the eye; and, to direct thelaser beam in a second pattern on a second portion of the lens of theeye; i) wherein the second pattern is configured to cut the lens intovolumetric shapes; ii) wherein the first pattern is configured to createan opening in the lens capsule for removal of the volumetric shapes;and, e) a 3-dimensional viewing apparatus, whereby the system isconfigured to provide a stereoscopic image of the lens.
 101. The systemof claim 100, wherein the second pattern is cubic.
 102. The system ofclaim 100, wherein the second shot pattern comprises a plurality ofnested shells.
 103. The system of claim 100, wherein the second shotpattern comprises a vertical cut that is parallel with an optical axisof the eye.
 104. The system of claim 100, wherein the second shotpattern comprises an annular cut that is parallel with an optical axisof the eye.
 105. The systems of claims 100, wherein the 3-dimensionalviewing apparatus comprises only a single ccd camera.
 106. The systemsof claims 101, wherein the 3-dimensional viewing apparatus comprisesonly a single ccd camera.
 107. The systems of claims 102, wherein the3-dimensional viewing apparatus comprises only a single ccd camera. 108.The systems of claims 103, wherein the 3-dimensional viewing apparatuscomprises only a single ccd camera.
 109. The systems of claims 104,wherein the 3-dimensional viewing apparatus comprises only a single ccdcamera.
 110. The system of claim 100, wherein the 3-dimensional viewingapparatus is configured to send 3-dimensional information to the controlsystem.
 111. The system of claim 110, wherein the 3-dimensionalinformation is a stereoscopic image.
 112. The system of claim 110,wherein the control system is configured to use the 3-dimensionalinformation to determine the shape of the lens.
 113. The system of claim110, wherein the control system is configured to use the 3-dimensionalinformation to determine the laser shot placement.
 114. The system ofclaim 110, wherein the control system is configured to use the3-dimensional information to determine the laser shot pattern.
 115. Asystem for delivering a laser beam to a lens of an eye in a plurality ofpatterns comprising: a) a laser; b) an optical path for directing alaser beam from the laser to the lens of the eye; c) a control systemconfigured to direct the laser beam in a first pattern on a firstportion of the lens of the eye; and, to direct the laser beam in asecond pattern on a second portion of the lens of the eye; i) whereinthe second pattern is configured to cut the lens into volumetric shapes;ii) wherein the first pattern is configured to create an opening in thelens capsule for removal of the volumetric shapes; and, e) a3-dimensional viewing apparatus, whereby the system is configured toprovide 3-dimensional information about the lens to the control system.116. The system of claim 115, wherein the 3-dimensional information is astereoscopic image.
 117. The system of claim 115, wherein the controlsystem is configured to use the 3-dimensional information to determinethe shape of the lens.
 118. The system of claim 115, wherein the controlsystem is configured to use the 3-dimensional information to determinethe laser shot placement.
 119. The system of claim 115, wherein thecontrol system is configured to use the 3-dimensional information todetermine the laser shot pattern.